Director of Compliance & QM

Job Summary: The Director of Quality Management and Compliance leads and champions the mission of ensuring delivery of safe, high quality client care services while assuring compliance with all local, state and federal accreditation and regulatory bodies that Southeastern Integrated Care is beholden to.

Essential Responsibilities:

• Serves on the Senior Leadership Team to lead appropriate integration of quality management and compliance strategies in the development and implementation of SEIC strategic plan.
• Oversees a corporate wide quality management program inclusive of all staff, develops and maintains a written quality improvement plan and annual evaluation of the plan’s effectiveness.
• Develops and maintains a performance measurement work plan and reporting calendar to ensure timely data collection, aggregation, analysis, and routine reporting of established performance measures related to key operational and clinical processes and outcomes.
• Leads and directs the Executive Committee in providing oversight and direction to the Leadership Team in assessing the appropriateness of care and service delivered and to continuously enhance and improve the quality of care and services provided to members.
• Leads improvement teams through the Plan Do Study Act cycle and reports on outcomes.
• Leads and directs all functions involving seeking and maintaining compliance with accrediting bodies to include CARF
• Manages electronic storage of quality improvement reports to promote ongoing access for key stakeholders.
• Oversees a corporate compliance program, develops and maintains a written corporate compliance plan and annual evaluation of the plan’s effectiveness; ensures that all required elements of a compliance program are addressed.
• Develops and maintains policies and procedures related to the corporate compliance program.
• Develops, oversees and provides for all training requirements of staff in accordance with clinical coverage policies of SEIC’s service lines
• Develops and maintains the written SEIC Code of Conduct and ensures staff and Board members receive the appropriate training/education.
• Serves as lead/director as designated by the Executive Director for all external and internal compliance audits; ensures that corrective action plans are documented in a timely manner and effectively implemented.
• Oversees investigations relating to reports of known or suspected violations of the corporate compliance program or Code of Conduct.
• In consultation with the Executive Director, submits mandatory notification of known or suspected corporate compliance violations to the appropriate regulatory agencies.
• Develops and maintains up-to-date knowledge of corporate compliance requirements and related laws and regulations as mandated or recommended by OIG, CMS, and other agencies; attends outside corporate compliance trainings provided by NC DHHS and/or other agencies as directed by the Executive Director
• Oversees a corporate wide risk management program, develops and maintains a written corporate risk management plan and annual evaluation of the plans’ effectiveness.
• Develops and maintains policies and procedures related to the corporate risk management program.
• Develops and oversees processes for internal incident reporting.
• Reviews incident reports and conducts follow-up investigations as warranted.
• Investigates and evaluates claims and potential claims.
• Oversees a corporate wide client safety program, develops and maintains a written client safety plan and annual evaluation of the plan’s effectiveness and develops and maintains policies and procedures related to the client safety program.
• Collaborates with the Clinical and Medical Directors and appropriate clinical operations staff in the investigation of clinical events including sentinel events, sentinel event near misses, and significant adverse events; leads and/or participates in the development of root cause analyses as directed by the CMO.
• Actively engages with external groups with quality management and regulatory practice focus, to include MCOs, local and state groups and other bodies, to ensure an active presence within the industry and stay up to date with current trends and changes impacting the agency.
• And other duties as assigned.

Job Qualifications and Skills:

• Master’s degree in public health, Healthcare Administration, Social Work, Psychology and 2-3 years of experience working in the healthcare field.
• Demonstrated leadership skills including excellent oral and written communication skills.
• Strong knowledge of healthcare clinical fundamentals, client safety standards, and performance improvement standards.
• Strong knowledge of CQI tools and techniques, ability to perform data analytics, and lead performance improvement teams
• Computer skills and knowledge of applicable software programs.
• Ability to work with diverse populations
• Flexibility with schedule