Director of Compliance

The Director of Compliance serves as the hospital’s Corporate Compliance Officer and oversees the Corporate Compliance Program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization and provides support to in house legal counsel.

Essential Duties and Responsibilities:

• Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct. Manages day-to-day operation of the Program.

• Develops and periodically reviews and updates Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.

• Collaborates with other departments (e.g., Human Resources) to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with the Corporate attorney as needed to resolve difficult legal compliance issues.

• Responds to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations.

• Acts as an independent review and evaluation body to ensure that compliance Issues/concerns within the organization are being appropriately evaluated, investigated and resolved.

• Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or deal with similar situations in the future.

• Manages the compliance Hotline.

• Works closely with internal and external legal counsel to provide administrative support and develop solutions for processes and procedures.
• Demonstrates clear ownership of workplace and patient safety.
• Reports mistakes, near misses, adverse events and quality and safety concerns.
• Participates in the development and implementation of safety and quality improvement activities.

• Other duties as may be assigned.

Job Requirements

Education:  Associates Degree required.  Bachelor’s degree preferred.

Licensure/Certification:

Experience:  Two years experience in healthcare leadership preferred.  Experience with auditing and compliance programs preferred. Understanding of applicable federal, state, local and hospital regulations.  Good interpersonal and communication skills.  Ability to recognize onsite risk factors and take appropriate action.  Excellent customer service skills. Ability to work independently and as part of team. 

Physical Requirements:  Frequent standing, walking and sitting.  Ability to reach, stoop, and bend.  Frequently lift up to 50 lbs.