Quality-Risk-Compliance Director

Quality Improvement, Risk Management, and Compliance (QRC) Director

Job Description

The QRC Director is a certified or provider level position. The QRC Director should have a bachelor’s degree in public health, Hospital Administration, Health Informatics, or similar degree OR have master's level degree in such area or be a licensed NP (Nurse Practitioner) or MD (Medical Doctor or Physician).

Job Summary: The QRC Director provides leadership and expertise to ensure the delivery of safe, high quality patient care services. The QRC reports to the Operations Director.

Essential Duties, but would not be limited to:

QUALITY IMPROVEMENT:

Ensuring the implementation of QI/QA (Quality Improvement/Quality Assurance) operating procedures, related assessments, and follows QI Plan as approved by the SICHC Board of Directors.

Monitoring QI/QA outcomes.

Updating QI/QA operating procedures

Providing direct oversight and approval of all activities done by the Quality Improvement Manager

Attending monthly QI Meetings

Reviewing and approving the quarterly and annual reports for the Board of Directors.

The QRC Director must be available as needed for assistance in activities done by the Quality Improvement Manager (QIM), when requested. They may be required to participate in grant projects that include the need or use of the QI Program, participate in insurance meetings, or attend conferences as determined by administration.

The QRC Director will hold the QI position on the Risk Management Team and be required to attend meetings as they arise.

RISK MANAGEMENT:

Develop systems for and overseeing the reporting of adverse events, near misses, and potentially unsafe conditions.

Analyze data collected on adverse events, near misses, and potentially unsafe conditions; providing feedback to providers and staff; and using this data to facilitate system improvements to reduce probability of occurrence of future related events.

Overseeing the organization’s systems for data collection and processing, information analysis, and generation of statistical trend reports for the identification and monitoring of adverse events, claims, finances, and effectiveness of the risk management plan.

Facilitating and ensuring the implementation of patient safety initiatives, by focusing on provider and staff educational programs to improve patient safety and reduce risks to patients, staff, and visitors.

Facilitating a culture of safety in the organization that embodies an atmosphere of mutual trust in which all providers and staff members can talk freely about safety concerns and potential solutions without fear of retribution.

Must be available outside of normal working hours if an emergent Risk Management meeting is required or requested by Administration or the Board of Directors.

Preventing and minimizing the risk of liability to the organization, and protecting the financial, human, and other tangible and intangible assets of the organization.

Decreasing the likelihood of lawsuits through the following: Effective patient and family communications and education plan, claims management processes and investigating and assisting in claim resolution to minimize financial exposure in coordination with the liability insurer and its representatives.

Evaluate and implement ongoing patient safety/risk management assessment and report on the recommendations through SICHC’s committee processes.

COMPLIANCE:

Oversee a corporate compliance program, develops 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.

Serves as a resource for the Operations Director(OD) 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 of Code of Conduct.

In consultation with the Chief Executive Officer (CEO), submits mandatory notification of known or suspected corporate compliance violations to the appropriate regulatory agencies, or may report directly to the board of directors.

Develops and maintains up-to-date knowledge of corporate compliance requirements and related laws and regulations as mandated or recommended by OIG, CMS, and other regulatory agencies; attends outside corporate compliance trainings provided by NACHC and/or other regulatory agencies as directed by the OD or CEO.