Description

JOB DESCRIPTION

JOB TITLE: Director, Quality

Improvement and Risk Management

STATUS: Exempt Full-Time

REPORTS TO: CEO

This job description is intended to be a general statement about this job and is not to be considered a detailed assignment. It may be modified to meet the needs of the organization.

JOB SUMMARY

Responsible for developing, implementing and monitoring quality management policies and procedures for quality data collection and reporting on HEDIS, UDS, Meaningful Use and PCMH measures. In addition, this position is also responsible for developing, implementing and monitoring the population health program and staff who will outreach to all active patients to encourage them to get their necessary visits done and to outreach specifically to high-risk clinic patients to help them get the needed visits, prescriptions, tests, education and procedures they need to improve their health status. This position will also work closely with the Executive Director on any additional quality measures the clinic chooses to pursue.

The QI/Risk Manager provides strategic and operational leadership pertaining to compliance and regulatory issues including but not limited to Human Resources, Finance, Clinical and Operations. The position oversees the development of a risk management program to assess, prioritize, and manages legal and regulatory compliance risks based on state/federal guidelines and requirements and benchmarking research, facilitating the systematic assessment and management of risks.

The role is also responsible for organization-wide confidential reporting systems allowing employees, patients, contractors, and other stakeholders to disclose violations of the Clinic's ethical standards, violations of law, or policy relating to such matters without fear of retaliation.

This position is a supervisory position and responsible for the selection and supervision of the Patient Navigators. This position will also work closely with the quality staff at the Council of Clinics IPA on their quality measures for IBCC's managed care patient population. This position staffs the monthly CQI meetings, preparing the agenda, quality reports and minutes, in conjunction with the Chief Medical Officer.

ESSENTIAL JOB FUNCTIONS

• Conduct ongoing assessments of the existing eligibility and referrals, case management, disease management systems, and Quality Management and Risk Management programs. Provide objective evaluation and recommendations for those systems.
• Review existing clinic information system capabilities for the tracking and monitoring of quality indicators. Make the necessary adaptations for standardized reporting across all clinics.
• Responsible for development, implementation and ongoing refinement of organization-wide strategies for an effective compliance, ethics and integrity and privacy/security program
• In collaboration with the Compliance Officer, develops, directs and maintains responsibility for the Clinic's compliance function and business ethics related to standard of conduct, including HIPAA/Hitech privacy and security compliance
• Reviews the content and performance of the Clinic Compliance Program including Medicare Part D, compliance policies and procedures, and the Code of Conduct on a routine basis and takes appropriate steps to ensure its effectiveness to prevent, detect and correct illegal, unethical, or improper conduct within the corporation
• Manages any investigations of alleged violations of law, policies and procedures, and the Clinic's Code of Conduct in consultation with the Compliance Office and General Counsel, and/or designated outside legal counsel, and takes appropriate corrective action
• Identify best clinical and business practices within the clinics. Recommend standardized systems and develop a plan to implement and monitor systems within and across the member clinics.
• Develop and maintain effective work plans to implement the IBCC Quality Management plan within each clinic.
• In cooperation with the Chief Medical Officer , develop clinical quality indicators that will be monitored for all clinics.
• Work with the IT department in the development of strategic and tactical plans to support the Quality Management program. Provide insights and real-world experience as the plan is developed to ensure ease of information technology access/utilization in the clinics.
• Effectively communicate the goals and objectives of the Quality Management and Risk Management program to each clinic's staff, the Chief executive Officer and Chief Medical Officer. Provide the necessary training and skills to effectively perform the activities outlined in the QI/RM program.
• Lead and provide administrative support to the clinic's Quality Management Committee.
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