RISK AND QUALITY ASSURANCE COORDINATOR

TITLE: RISK AND QUALITY ASSURANCE COORDINATOR

DEPARTMENT: ADMINISTRATION

SUPERVISOR: COMPLIANCE OFFICER

CLASSIFICATION: NON-EXEMPT FULL-TIME

POSITION SUMMARY:

The Risk and Quality Assurance Coordinator is responsible for managing risk mitigation processes, ensuring compliance with healthcare regulations, and supporting the continuous improvement of quality assurance efforts within the clinic. This position plays a crucial role in ensuring patient and staff safety, enhancing the quality of care, and maintaining the highest standards of operational excellence. Additionally, the Coordinator will handle patient complaints, ensuring timely resolution and effective communication.

ESSENTIAL JOB FUNCTIONS:

• Risk Management: Identify, assess, and monitor potential risks to patient safety, staff wellbeing, and operational efficiency. Develop and implement risk management strategies and protocols to minimize incidents and improve overall safety. Manage organizational incident tracking system. Lead investigations of adverse events and incidents, providing recommendations for corrective actions. Track and report key risk indicators and trends, making datadriven recommendations for improvements. Collaborate with Safety and Security Manager and provide meeting coordination and documentation for Safety Committee.
• Quality Assurance: Oversee the development, implementation, and maintenance of quality assurance processes to ensure optimal patient care. Collaborate with clinical and administrative teams to develop and update policies, procedures, and guidelines that meet regulatory standards. Conduct audits and assessments of clinical practices, patient records, and operational procedures to ensure compliance with state and federal regulations. Coordinate training and education sessions for staff on quality improvement initiatives and risk management practices. Collect and analyze performance data to identify opportunities for process improvement and to monitor the effectiveness of corrective actions.
• Patient Complaints and Communication: Serve as the primary contact for patients who have complaints or concerns about their care or experience at the clinic. Investigate patient complaints thoroughly, ensuring that issues are addressed promptly, accurately, and professionally. Communicate with patients to gather information, discuss their concerns, and explain the steps taken to resolve their complaints. Track and document patient complaints and resolutions to ensure consistent followup and improve future patient experiences. Work with clinical and administrative teams to ensure that corrective actions or process improvements are implemented in response to patient feedback. Provide feedback and recommendations to leadership regarding recurring patient concerns and potential improvements to care or services. Support patient experience initiatives.
• Regulatory Compliance: Ensure adherence to all relevant healthcare regulations, including safety standards, patient privacy laws, and accreditation requirements. Support Compliance Officer with policy development and tracking. Perform compliance activities including auditing and monitoring. Work closely with leadership to prepare for inspections and accreditation surveys, ensuring all necessary documentation and procedures are in place. Maintain uptodate knowledge of healthcare industry regulations, reporting any changes to management and making necessary adjustments to clinic practices.
• Collaboration and Communication: Work collaboratively with various departments, including clinical, administrative, and executive teams, to ensure alignment in risk management and quality assurance efforts. Prepare reports and presentations for management as requested. Design, implement and maintain educational programs on risk management, safety, and compliance topics. Serves as the point person for the implementation of new systems supporting administrative quality initiatives. Provides support for administrative projects and backup to other administrative roles as assigned.
• Performs miscellaneous jobrelated duties as assigned.

EDUCATION, EXPERIENCE, CERTIFICATIONS AND LICENSES:

• Bachelor’s degree in Healthcare Administration, Nursing, or a related field (Master's degree preferred).
• Minimum of 35 years of experience in risk management, quality assurance, or healthcare compliance.
• Strong understanding of healthcare regulations, patient safety standards, and quality improvement methodologies (e.g., Lean, Six Sigma).
• Experience with data analysis, incident reporting systems, and quality improvement tools.
• Experience in handling and resolving patient complaints in a healthcare setting.
• Excellent communication, interpersonal, and organizational skills.
• Ability to work independently and as part of a collaborative team.
• Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint) and other healthcare management software.
• Knowledge of California state healthcare laws and regulations is preferred.

All LCTHC employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the LCTHC policies and procedures as they may from time to time be updated.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Sitting / Mobility: Approximately 60% of time is spent working at a desk. Balance of time (approximately 40%) is spent moving around work areas. Communication: Ability to effectively communicate with co-workers, Board members, members of outside agencies, in person, by telephone, and by email. Vision: Ability to effectively use a computer screen and interpret printed materials, memos, and other appropriate paperwork. Lifting / Carrying: Ability to occasionally lift and/or move objects weighing no more than 50 pounds. Stooping / Kneeling: Ability to access files/stock supplies in low cabinets and shelves. Reaching / Handling: Ability to input information into computer systems and retrieve and work with appropriate paperwork, equipment, and supplies. Use of standard office equipment, including computer, telephone, calculator, copiers, and fax. Work is performed in an office/clinic environment; continuous contact with other staff and the public.

INDIAN PREFERENCE: Preference may be given to qualified Native American Indians according to the Indian Preference Hiring Act, CFR 25 USC 472. Other than Indian Preference, Lake County Tribal Health Consortium, Inc. adheres to all provisions of the Equal Employment Opportunities Act.

NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT: LCTHC is committed to maintaining a drug free and alcohol-free workplace. LCTHC believes that a healthy, productive workforce free from the effects of drugs is very important to all employees and patients. Substance abuse is incompatible with the health, safety, efficiency and success of LCTHC. Employees who are under the influence compromise LCTHC’S interests, endanger their own and the health and safety of others and can cause a number of other work-related problems. As a condition of employment, each applicant receiving a job offer from LCTHC must take and pass a required drug screen test.

HIPAA Health Insurance Portability and Accountability:

This act was enacted to deal with three main areas with regard to patient information.

• Security of health information
• Standards of electronic transactions
• Privacy of individually identifiable health information

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Lake County Tribal Health is an At-Will Employer. Either the employee or LCTHC can terminate the employment at will, without advance notice, at any time, with or without cause.