Compliance Manager - Healthcare jobs in Paramus, NJ

Compensation

$85000.00 - $110000.00 per year

Minimum Years of Experience

3 years

Minimum Level of Education

Master’s

DESCRIPTION

JOB SUMMARY:

The Quality Manager reports to the Medical Director and is responsible for compliance, quality, and policy development in accordance with Visiting Docs’ policies. The Quality Manager will reflect the mission, vision and value statements of Visiting Docs in the health center and communities that we serve.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Develop, implement and oversee quality improvement to ensure delivery of the highest quality patient care, optimal patient flow, provider productivity and continuity of care.
• Develop a conceptual framework for quality measurement and improvement activities across clinic sites. Summarize findings in the Quality Improvement (QI) Plan.
• Work with Medical Director and Executive team as well as other members of Management to develop and ensure the implementation of policies to minimize risk within the organization.
• Manage and oversee clinical measures and population health for best outcomes.
• Coordinate with various personnel to develop audit systems, perform data analysis and prepare reports related to measuring objectives and tracking outcomes as required by grants, contracts or HHC need. Analyze and report data, as required, in conjunction with the QI Reporting calendar.
• Coordinate with the Medical Director, Executive Director as well as other members of Management to organize and lead chronic disease care improvement efforts.
• Participate in quality components of CCPM – Accountable Care Organization.
• Work with Medical Director and Executive Director to monitor and track organizational performance.
• Work with the Medical Director and Executive Director to develop new or update existing clinical outcome measures, protocols, policies and procedures to ensure compliance with policies through a peer review process.
• Engages in the planning and implementation of the Corporate Compliance Program, including risk management reduction, which includes ensuring compliance with Visiting Docs’ policies and procedures as well as health, safety and regulatory requirements including HIPAA, OSHA, and CLIA.
• Investigate and act, in conjunction with Medical Director and Executive Director, on matters related to compliance, including coordinate internal investigations and any resulting corrective action with all departments, contracted vendors, etc.
• Develop and review policies and programs that encourage managers and employees to report suspected fraud or other improprieties.
• Participate in long-range planning including the evaluation of patient satisfaction, current services and programs to increase, and market services to the community and to position Visiting Docs for change and growth.

NON-ESSENTIAL DUTIES AND RESPONSIBILITIES: 

Performs other duties as assigned.

COMPETENCIES:

• Strong level of confidentiality due to the sensitivity of materials and information handled.
• Computer literacy.
• Excellent written and oral communication skills.
• Good organizational skills to handle multiple priorities while remaining professional and calm.
• Ability to work with many diverse people.
• Effective telephone skills.
• Written and verbal communication and problem-solving skills.
• Demonstrated effectiveness in the realization of performance objectives and previous experience in performance-based evaluations.
• Ability to work as a liaison with patients, government agencies, grantors, managed care and other health care organizations to coordinate quality measurement and performance activities and possess the ability to communicate with people from a variety of socioeconomic and cultural backgrounds.
• Ability to prioritize, organize, carry out work assignments independently and efficiently and have the ability to work independently and be self-directed and flexible.
• Must be able to make suggestions on workflow or system efficiency and effectiveness.
• Ability to build and motivate teams with demonstrated leadership and facilitation experience.
• A commitment to the mission of Visiting Docs.

GENERAL EXPECTATIONS:

• Be committed to the mission of Visiting Docs.
• Behave in a professional manner and consistently demonstrate and promote the values of respect, honesty, and dignity for the patient, families, and all members of the healthcare team.
• Committed to the constant pursuit of excellence and teamwork in improving the care of the patient and families of Visiting Docs. Be punctual for scheduled work and use time appropriately.
• Be punctual for scheduled work and use time appropriately.
• Perform duties in a conscientious, cooperative manner.
• Perform required amount of work in a timely fashion with a minimum of errors. Be neat and maintain a professional appearance.
• Be neat and maintain a professional appearance.
• Maintain confidentiality and protect the Practice by abiding by laws and principles related to confidentiality; keep information concerning Practice Operations, patients and employees confidential.

PHYSICAL REQUIREMENTS: 

The physical requirements described here are representative of those that must be met by the Incumbent to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential  functions. The employee is regularly  required to sit for prolonged periods of time, and talk and hear. The employee is occasionally required to stand, walk and use hands to operate a standard computer keyboard. The employee may occasionally lift and/or move up to 10 pounds. Vision requirements include close vision, distance vision, depth perception, and the ability to adjust focus.

WORK ENVIRONMENT: 

The work environment characteristics described here are representative of those the incumbent encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in a busy medical office environment with many interruptions. Very active, fast paced position with short deadlines.

QUALIFICATIONS NEEDED FOR POSITION: 

The following experience and skills are considered essential:

• Understanding of clinical quality guidelines, compliance and policy development.
• Ability to work collaboratively.
• Ability to communicate effectively with Senior Management Team, Providers and all staff.
• Strong knowledge of Article 28, Medicare, Medicaid, and valued based programs.
• Previous experience working in Assisting Living Facilities and/or Nursing Homes.
• Previous experience with an EMR required; experience with eCW preferred.

EDUCATION REQUIREMENTS: 

The following education requirements are considered essential:

• Nurse Practitioner or health related degree and current licensure, as applicable, in nursing, public health or equivalent.
• A minimum of three year’s related work experience in quality management, utilization or risk management areas or equivalent combination of education and experience. 

LICENSURE REQUIREMENTS: 

Current state licensure as an Nurse Practitioner or equivalent experience as risk/quality manager.