Quality Management & Compliance Specialist - Residential

About Company

We are looking for mission driven professional leaders who want to be part of a collaborative and dynamic team. Regardless of title, you will be a vital member and leader of a powerful team. Southeastern Integrated Care is dedicated to providing quality care and support to individuals struggling with behavioral health disorders , substance use disorders, and chronic medical conditions. By joining us, you would have the opportunity to make a significant impact on the lives of those in need, helping them on their journey to recovery, and improved mental well-being. We pride ourselves on having a team of committed and highly trained professionals who are passionate about making a difference in the field of behavioral health, substance use disorders, and chronic care . Working alongside such a team would foster a collaborative environment where you can exchange knowledge, share experiences, and learn from one another, ultimately enhancing your expertise and professional growth. Our supportive and empowering culture allows for us to provide cutting edge care and innovative treatment approaches

We are a company that provides our team members with a quality and comprehensive onboarding experience, amazing supervision and coaching, paid educational and training opportunities, and opportunities for advancement within our organizations. We believe that our team is number one, comes first, and that the clients and patients we serve are our number one priority. If you are a highly skilled professional with a leadership mindset, Southeastern Integrated Care is the ideal place for you to thrive, and make a difference. Our competitive salary, paid healthcare benefits options, matching 401k plan, bonus and stipend structures afford you and your family the financial support needed for you to focus on saving lives and providing the best opportunity for our clients to reach their maximum potential. If this is the type of environment you choose to work in, then Southeastern Integrated Care has a place for you.

Summary

Quality Management and Compliance Specialist - Residential is responsible for maintaining and operationalizing quality and compliance procedures and developing organizational strategies to ensure that Southeastern Integrated Care and affiliates complies with all federal, state, and local regulations as well as industry best-practices. Assures compliance in accordance with Southeastern Integrated Care, Inc’s Purpose, Vision, and Mission while adhering to applicable NC 10A NCAC 27G and assigned Clinical Coverage Guidelines 8A, C, D and G.

Essential Duties And Responsibilities

• Oversees a corporate wide quality improvement program inclusive of all staff, develops and maintains a written quality improvement plan and annual evaluation of the plan’s effectiveness.
• Develops and maintains a performance measurement work plan and reporting calendar to ensure timely data collection, aggregation, analysis, and reporting of established performance measures related to key operational and clinical processes and outcomes.
• Assures SEIC and affiliates are CARF survey ready at all times.
• Leads improvement teams through the Plan Do Study Act cycle and reports on outcomes.
• Manages electronic storage of quality improvement reports to promote ongoing access for key stakeholders.
• Oversees a corporate compliance program, assists with development and maintains a written corporate compliance plan and annual evaluation of the plan’s effectiveness; ensures that all required elements of a compliance program are addressed.
• Develops and maintains policies and procedures related to the corporate compliance program.
• Coordinate with training department to ensure staff training is in compliance with clinical coverage policies.
• Oversees the implementation of the SEIC Code of Conduct.
• Serves as a resource for the VP of Program Operations and VP of Clinical Operations for all external and internal compliance audits; ensures that corrective action plans are documented in a timely manner and effectively implemented.
• Oversees investigations relating to reports of known or suspected violations of the corporate compliance program or Code of Conduct.
• In consultation with the VP of Program Operations and submits mandatory notification of known or suspected corporate compliance violations to the appropriate regulatory agencies.
• Develops and maintains up-to-date knowledge of corporate compliance requirements and related laws and regulations as mandated or recommended by OIG, CMS, CARF, and NCDHHS and other agencies; attends outside corporate compliance trainings provided by NC DHHS, CARF and/or other agencies as directed by the VP of Program Operations.
• Oversees a corporate wide risk management program, participates in the development/updating and maintains a written corporate risk management plan and annual evaluation of the plans’ effectiveness.
• Develops and maintains policies and procedures related to the corporate risk management program.
• Develops and oversees processes for internal incident reporting.
• Reviews incident reports and conducts follow-up investigations as warranted.
• Investigates and evaluates claims and potential claims.
• Oversees and assures compliance with NC Records management and Documentation Manual.
• Oversees a corporate wide client safety program, develops, and maintains a written client safety plan and annual evaluation of the plan’s effectiveness and develops and maintains policies and procedures related to the client safety program.
• Collaborates with the Chief Medical Officer (CMO) and VP of Program Operationsin the investigation of clinical events including sentinel events, sentinel event near misses, and significant adverse events; leads and/or participates in the development of root cause analyses as directed by the CMO.
• Manages industry and regulatory compliance responsibilities and obligations of the Company including direction, strategic development, performance, and maintenance;
• Reviews Company practices, documents, and policies to ensure compliance;
• Establishes and maintains compliance management systems in accordance with Organization plans, adherence to legislation and agreed regulatory bodies’ processes and procedures;
• Conducts documentation audits as needed;
• Creates and facilitates compliance trainings
• Collaborates with leadership to develop core compliance objectives;
• Will communicate to VP of Program Operations, VP of Clinical Operations, COO and CMO, SEIC risk management issues and concerns as needed.
• Other duties as assigned by VP of Program Operations.
  
  

Supervisory Responsibilities

As assigned by VP of Program Operations.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience

• Preference of 2 years supervisory experience in a clinical or legal setting;
• Bachelor’s degree in business administration, economics, legal studies, management, healthcare, or another related field;
• Minimum 5 years’ experience in a compliance related field;
• A combination of experience and education may be acceptable;
  
  

Required Skills/Abilities

• Demonstrated ability to analyze and interpret industry laws and regulations;
• Strong leadership skills;
• Knowledge of industry best practices;
• Ability to address and resolve issues while ensuring alignment with Company strategic goals;
• Ability to negotiate, problem solve, manage multiple tasks simultaneously and meet deadlines;
• Excellent verbal and written communication skills; proficient computer skills;
• Culturally competent;
• Demonstrated proficiency with Microsoft Offices/Google Workspace applications;
  
  

Certificates, Licenses, Registrations

• QP designation or above
• CPR, first aid, NCI, and/or role-related certification OR within 3 months of hire.
• CARF Accreditation Surveyor distinction preferred
  
  

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work is typically performed in an office environment, with a moderate noise level.

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Movements including but not limited to prolonged periods of sitting at a desk and working on a computer, occasional standing, walking, bending, and reaching are required.
• Regularly required to use hands to manage or feel; talk; see; and/or hear. Specific vision abilities required by this job include close vision and color vision.
• Must be able to lift up to 15 pounds at all times.