Regional Medical Services Compliance Manager

Description

Bonus: $15,000 - $20,000 discretionary sign on, paid out in 3 installments with a 3-year service commitment

Position Summary:

The Regional Medical Services Compliance Manager is responsible to ensure congruity of organization policies and procedures within the medical services of Catholic Charities. The Regional Medical Services Compliance Manager works collaboratively with the Director of Clinical Practice and positions responsible for administrative infrastructures including Finance, Information Systems, and Human Resources as well as the site Directors, Chief Operating Officer and Clinical Services. This position will serve the whole organization, so can be based in our offices in Wenatchee, Yakima, or Richland.

Responsibilities:

Financial Oversight and Management

• Monitors financial performance, ensuring cost-effectiveness and adherence to budgetary constraints.
• Collaborates with finance teams to secure funding, grants, and other financial resources to support program goals and expansion.
• Interfaces with federal and state payment structures to ensure compliance and advance alternate payment models that are advantageous for the organization.

Facilitate care of clients served in an Integrated Health Care environment

• Provides consultation and assists the Catholic Charities clinical team as needed.
• Coordinates and/or consults with primary care physicians to monitor compliance standards for psychiatric or medical management of a consumer under Catholic Charities care for transition of medical care.
• Assists with the compliance, education and training of clinical staff regarding diagnoses, treatment planning use and abuse of medications, health maintenance, and related clinical issues.

Provides and oversees Catholic Charities’ medical services in an integrated behavioral health and primary care environment

• Assists psychiatric staff providing compliance information, HIPAA standards and industry recommended assessments, prescribing, and medication management.
• Assists Providers regarding clinical psychiatric services and integrates behavioral health services with primary care.
• Facilitates opportunities for compliance consultation among Catholic Charities medical providers.
• Provides oversight and assists with day-to-day operations of medical services.
• Ensures all medical services are input into the Electronic Medical Record (EMR) and meet integrated healthcare standards.
• Uses the EMR to develop, implement, and maintain a process for concurrent documentation for physical health and behavioral health providers to have access to each other’s documentation.
• Reports to the Compliance Officer and North Central Director regarding the operations of the physical and integrated healthcare programs, benefits of client participation in integrated care, monitoring and management as necessary to assure optimal benefit to consumers.
• Disseminates information to the team regarding physical and integrated behavioral healthcare.

Quality Improvement

• Sets benchmarks and targets related to healthcare quality, efficiency, and outcomes.
• Establishes measurable goals and monitors progress using data-driven insights, including assessing cost-effectiveness, clients’ satisfaction, and overall effectiveness of the healthcare programs.
• Collaborates with key staff and plays a pivotal role in achieving healthcare transformation.
• Collaboratively, implements changes that improve service delivery, leverages innovative practices, and adapts to evolving healthcare landscapes.
• Supports team members through compliance measures regarding physical and integrated healthcare services.
• Offers expertise, training, and mentorship to ensure staff members are equipped to deliver high-quality care.
• Explores ways to improve care through information technology and collaborates with information technology specialists to improve service delivery.

Compliance and Regulatory Adherence

• Ensures compliance with all relevant healthcare regulations, including HIPAA, state licensing requirements, and other healthcare standards.
• Establishes and implements policies and procedures that align with regulatory guidelines to maintain a high standard of care and legal compliance.
• Conducts regular audits and assessments to proactively identify and address any compliance gaps or issues.
• Ensures that all clinical documentation adheres to regulatory standards and best practices.
• Implements and monitors compliance with healthcare policies, procedures, and legal requirements, ensuring accuracy and completeness in clinical documentation.
• Keeps abreast of changing healthcare regulations, policies, and compliance standards.
• Participates in policy development or revision process to ensure services align with legal and regulatory requirements while promoting best practice.

Recruitment

• May provide patient and staffing data and recommendations to the Compliance Officer and Behavioral Health leadership, based on the scope of services provided and utilizing information about current patient volumes, anticipated growth, and specialized skills required to ensure comprehensive psychiatric evaluations and medication management.
• Actively participates in the recruitment process, contributing insights into the evaluation of potential candidates.
• May be involved in candidate interviews, assessments, and discussions to ensure alignment with the healthcare facility's vision, mission, and quality standards.

Prospection

• Analyzes current healthcare trends, community needs, and gaps in services to anticipate future demands.
• Develops strategic plans that identify opportunities for expanding psychiatric evaluations, medication management, or integrated healthcare services for both children and adults.
• Stays abreast of advancements in medical technology, treatment modalities, and healthcare practices.
• Researches and evaluates emerging therapies, digital health solutions, and innovative treatments to improve patient care and outcomes.
• Anticipates and provides input to the Compliance Officer and Behavioral Health leadership around resource requirements, such as staffing, funding, equipment, or infrastructure.
• As requested, conducts needs assessments, projects budgetary needs, and advocates for necessary resources to support envisioned healthcare initiatives.

Perform other duties as assigned

Qualifications

Job Requirements:

The following requirements are those that are normally required for performance of this position.  Any disabled applicant or incumbent who does not meet one or more of the physical requirements, but who can perform the essential function of the job (with or without reasonable accommodations) shall be deemed to meet these requirements.

Physical Requirements:

This position normally requires the physical demands of standing, walking, bending, lifting or performing other work requiring low physical exertion, talking and hearing on a regular basis to perform the job requirements.  These physical demands are required up to 80% of the time.  Position also requires ability to drive with adequate vision.

In emergency situations, could be exposed to unpredictable and assaultive clients. Exposure to communicative disease/illness could occur. Travel will be required as well as occasional evening or weekend hours.

Non-Physical Requirements:

Education

• Bachelor’s degree in science and nursing (BSN) required
• Master’s degree in science and nursing (MSN) or related field preferred

Experience

• 3 to 5 years’ experience in psychiatric client care and/or administrative/medical management required
• Experience with supervisory responsibilities preferred
• Experience within an integrated behavioral and physical healthcare clinic preferred

Special Skills

• Conceptual and program development skills
• Excellent oral and written communication abilities
• Demonstrated skills in psychiatric assessment, prescribing, and medication management
• Excellent judgment, relationship building and interpersonal skills
• Ability to provide culturally relevant medical services
• Ability to provide professional consultation with colleagues
• Ability to document in an Electronic Medical Record

Licensure, Registration, Certification

• RN license in Washington State
• Valid Washington State Driver’s License and minimum required liability insurance for WA State
• Must be deemed insurable as determined by Catholic Charities insurance liability provider

Employment is conditional upon:

• Being cleared by criminal background check and fingerprinting when required

Salary : $95,000 - $115,000