The Compliance and Risk Management Manager plays a crucial role in fulfilling the commitment of Community Medical Centers, Inc. (CMC) to provide the best quality of care possible as well as the continuous assessment and improvement of the quality of care and the services. This position has the principal authority and responsibility for the development, implementation, oversight and evaluation of a dynamic integrated risk management program and compliance program across all CMC clinical and business units. This position reports to the General Counsel.
Oversee, develop, and implement a comprehensive compliance strategy that includes periodic audits, effective lines of communication, written practice standards and procedures and an updated Compliance Plan that reduces CMCs vulnerability to fraud and abuse and ensures compliance with federal and state regulations.
Develop and implement a systemic approach for managing and minimizing clinical and enterprise risk that facilitates early identification of new risks, communication, issues management and internal and external reporting.
Develop guides and resources on compliance and risk management topics and provide training, knowledge, and skills to staff.
Oversee, develop, and implement compliance and risk management policies and procedures.
Responsible for insurance management, requests for certificates of insurance and review of insurance and liability clauses in contracts.
Act as Privacy Officer of the organization and be responsible for all duties associated with this position, including the investigation of and reporting of HIPAA violations and the composition and delivery of responses to state regulatory agency complaints and inquiries.
Lead organizations efforts for the HRSA On Site Visit, including gathering documents, ensuring reviews and Board approval of policies and procedures, and ensuring contract and subaward compliance with HRSA requirements.
In collaboration with the Security Officer, review HIPAA regulations for technology management and participate in conducting required controls including the periodic Risk Assessments.
In collaboration with clinical leaders, oversee the clinical risk management processes to ensure a culture of safety, timely capture of events, reporting to insurance and federal agencies and initiation of risk analysis for all events.
Ensure that the HHS OIG's List of Excluded Individuals and Entities, and the General Services Administration's (GSA's) List of Parties Debarred from Federal Programs have been checked with respect to all employees, medical staff and independent contractors.
Monitor the Compliance Hotline and independently investigate allegations of noncompliance and monitor appropriate corrective action and/or subsequent compliance.
Serve as the Chair of the Corporate Compliance and the Risk Management Committee.
Conduct an annual enterprise risk assessment for the organization and report findings to the Board of Directors and key management staff.
Report on a regular basis to the Board of Directors on the risk and compliance framework implemented at the health center to instill both confidence and understanding of policies and procedures.
Implement and monitor corrective action plan and/or subsequent compliance developed after compliance investigations