Compliance, Risk & Quality Management Specialist

The Compliance, Risk, & Quality Management Specialist establishes and implements the compliance program to assure Klamath Health Partnership (KHP) meets all regulatory program compliance and quality guidelines and to prevent illegal, unethical, or improper conduct.
The Compliance, Risk, & Quality Management Specialist directly assists and supports the Quality Management manager in providing strategic oversight and operational oversight to the performance measurement, reporting, and improvement initiatives of KHP while maintaining the integrity of the infrastructure and systems that support KHP in generating and optimizing the use of comparative measures.
The Compliance, Risk, & Quality Management Specialist is responsible to identify and mitigate legal, financial, and safety risks to the organization, employees, and clients.
The Compliance, Risk, & Quality Management Specialist will provide day-to-day assistance to the Quality Manager in ensuring implementation of continued education of clinical orientation of staff/physicians while ensuring that all training is customer-focused and based on identified need.
The position will support the Quality Manager’s partnership with management to implement Electronic Health Record solutions, reporting, quality assurance measures, and clinical decision support systems.
The Compliance, Risk, & Quality Management Specialist will also manage the operation of the organization- wide risk management and patient safety programs and provide guidance to clinical staff.
The position serves as the KHP Risk Manager and will be responsible for the development and maintenance of systems within the organization to detect, monitor, prevent, organize, measure, investigate, report, and manage patient adverse events, malpractice claims, incident reports, and other indicators of potential patient harm.
*Essential Duties and Responsibilities: * * Effectively uses new and existing tools, methodologies, and technologies to solve business problems and provide solutions that enhance operations and capabilities.
* Strives to streamline processes and implementation.
Ensures proper documentation.
* Facilitate performance improvement and health data analysis among providers and multiple levels of management.
* Manages quality assurance program including patient grievances, patient satisfaction and experience surveying, and Patient-centered Primary Care Home certification.
* Assists Quality Manager in the functions and operations of a robust continuous quality and performance improvement program including reviewing records for indicators of quality, reports finding to leadership, and coordinates agency Quality Council.
* Develops, initiates, maintains, and revises policies and procedures for the general operation of the compliance program to assure compliance in all areas of KHP operations (HIPAA/HITECH * Privacy, Security Rules, HRSA Program Compliance, OIG Compliance, Clinical Compliance, Workplace Safety, etc.
) and related activities to prevent illegal, unethical, or improper conduct.
* Assists with the proper receipt and resolution of client complaints and grievances.
Ensures appropriate of grievances to required entities.
* Consistently and accurately advise and educate staff regarding HIPAA and 42 CFR requirements and medical record documentation guidelines.
* Monitor internal client privacy by tracking, investigating, reporting, and responding to staff privacy concerns and questions.
* Monitor HIPAA Compliance including screening in or out possible HIPAA breaches; conduct HIPAA breach investigations if the incident is screened in; complete HIPAA breach notifications and reporting; and, respond to staff HIPAA questions and concerns.
* Receive, process, and investigate claims of Fraud, Waste and Abuse.
* Provides advice regarding EHR functionality and capabilities to the Quality Manager and Clinical Application Specialist.
* Assist in ensuring that the agency's EHR operates according to internal standards, external accrediting agency standards, and legal requirements.
* Complies with federal, state, and local legal requirements by studying existing and new legislation, enforcing adherence to requirements, and advising management on needed actions.
* Remains available and flexible to provide spontaneous technical assistance to end users, while simultaneously prioritizing and accomplishing core duties.
* Supports the Quality and Business Intelligence team in the implementation and updates to processes and tools that support quality improvement review operations (reports, audits, staff educational documents, tools, and EHR forms).
* Use sound judgment, make efficient and thoughtful decisions, act with integrity and maintain confidentiality.
* Proactively evaluate areas of organizational risk based on internal assessment and external benchmarking and implement strategies and policies that promote patient and staff safety.
* Promote the occurrence reporting process including trending and reporting of results, identification of problem-prone areas, and facilitation of prevention initiatives.
* Monitor the investigation of all potentially compensable events (preventable adverse events).
* Lead the review of serious occurrences requiring root-cause analysis or failure mode and effects analysis.
Disseminate lessons learned and process improvement plans.
* Meet regularly with leadership to provide detailed reports on all serious incidents, claims, and risk-related issues.
* Respond to sentinel events and other serious occurrences and provide expert advice on the management and reporting of such events to administrative and clinical leadership and staff.
* Conduct immediate/appropriate response to any serious occurrence/complaint representing actual or potential patient, visitor, or employee injury.
Monitor and take subsequent actions to ensure learning, compliance, and documentation.
* Analyze all statistical reports and advisories that identify risk management and patient safety patterns and trends for leadership.
*Other Duties: * * Builds and supports effective collegial relationships with applicable internal and external constituents and stakeholders.
* Responsible for driving, supporting, and modeling a service-oriented culture focused on service excellence and the overall patient experience across facilities.
* Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
* Provides all patients of KHP with an excellent service experience.
*Desired Knowledge, Skills, and Abilities: * * Experience operating in Federally Regulated Environment * Experience ensuring regulatory compliance, oversight, and enforcement of policy, standards, statutes, codes, and regulations while maintaining operational effectiveness.
* Strategic and opportunistic thinker * Ability to utilize and integrate multiple resources to identify quality measures.
* Ability to quickly assimilate, assess, and act upon new concepts, trends, and initiatives.
* Ability to learn and apply continuity of care principles in establishing workflows with providers and staff.
*Qualifications * Preferred: * Bachelor’s degree in health care, public administration, business management, or related field, or * 3 years relatable work experience in quality management, risk management, and federal regulatory compliance.
* Extensive knowledge of compliance and state regulations is preferred.
* High-energy, organized, persistent, and creative individual with strong communications, interpersonal, and systems thinking skills.
* Proven management ability and experience including a thorough understanding of quality improvement (QI) processes, tools, and techniques; quality measurement and reporting; root cause analysis and preventive risk management strategies; accrediting bodies’ standards; and state and federal regulations.
* Experience with standard Microsoft Office or related products required and experience in database management and systems development desired.
* Knowledge of risk information management systems (RIMS).
* Ability to function effectively, independently, and efficiently in a stressful and dynamic work environment.
*Accommodations * The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk and hear.
The employee frequently is required to stand, walk, sit, and use hands to finger, handle or feel.
The employee must occasionally lift and/or move up to 25 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception and ability to adjust focus.
The work environment described here represents those that an employee must meet to successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Job Type: Full-time Pay: From $50,000.
00 per year Benefits: * Dental insurance * Employee assistance program * Health insurance * Health savings account * Life insurance * Paid time off * Retirement plan * Vision insurance Schedule: * 8 hour shift * Monday to Friday Education: * Bachelor's (Preferred) Experience: * Quality Management: 3 years (Preferred) Ability to Relocate: * Klamath Falls, OR 97601: Relocate before starting work (Required) Work Location: In person