COMPLIANCE ANALYST

COME AND JOIN THE RMC FAMILY! 

We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.
Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

SUMMARY:  Responds to grievances and concerns, health plan inquiries, generate correspondence with patients to acknowledge complaints. Aid patients and staff in resolving problematic issues. Take calls from Physicians and staff regarding QM issues and concerns. Assists in implementing the activities of quality assessment and performance improvement in Patient Safety and related areas. Assures compliance with regulatory agency requirements.

QUALIFICATIONS:  To perform this job successfully, an individual must be able to perform each essential function 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 and/or EXPERIENCE:  High school diploma or general education degree (GED); or one to two years related experience and/or training; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, AND REGISTRATIONS:  None.

LANGUAGE SKILLS:  Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write reports and correspondence.  Ability to speak effectively before groups of customers or employees of the organization.

MATHEMATICAL SKILLS:  Ability to calculate amounts and figures such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.  Ability to apply concepts of basic algebra and geometry.

REASONING ABILITY:  Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.  Ability to deal with problems involving several concrete variables in standardized situations.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:  The physical demands and work environment characteristics 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 a disability to perform the essential functions. While performing duties of job, employee is occasionally required to stand; walk; sit; use finger, handle, or feel objects tools, or controls reach with hands and arms; talk and hear.  Employee must occasionally lift and or move up to 25 pounds.  Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to focus.

WORK ENVIRONMENT:  The noise level in the work environment is usually moderate.

ESSENTIAL FUNCTIONS:

Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job’s purpose and objectives.  Essential functions are critical or fundamental to the performance of the job.   They are the major functions for which the person in the job is held accountable.  Note:  (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).

1. Responds to grievances and concerns, gather data and investigate issues. Meet with medical director for resolution and follow up.

1. Respond to health plan inquiries under supervision of QRM Medical Director.

1. Review data related to quality of care concerns and recommend a plan of action.

1. Generate correspondence with patients to acknowledge complaints.

1. Notify patients of review outcome when they have requested a monetary refund.

1. Maintain confidentiality of internal and external clients.

1. Attend RMC Nursing QA meetings & serves as a resource.

1. Perform focused audits in clinic areas as needed or requested by department managers.

1. Assist with development of departmental policy and procedures as required.

1. Take calls from Physicians and staff regarding QM issues and concerns.

1. Assure follow up of Medical Practice Committee action items.

1. Prepare and send memos to providers under direction of Medical Director.

1. Assist with audits, surveys and studies.

1. Report outcomes to committees.

1. Assist clinical staff and physicians in interpretation and application of corrective action plans.

1. Perform Facility Site Audits on new providers and re-audits in conjunction with re-credentialing.

1. Collection of data and investigation of occurrence reports.

1. Regulatory Compliance (AAAHC; Health Plan Audits/CAP Monitoring/Work plans/Provider Evaluations.

1. Assist Vice President as needed in QM or RM activities.

BENEFIT HIGHLIGHT:
• Challenging and rewarding work environment.
• Competitive compensation and paid time off.
• Excellent Medical, Dental, Vision and Life Insurance Plans.
• 401(K) with company match and discounted stock plan.

ABOUT UNIVERSAL HEALTH SERVICES

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

EEO STATEMENT

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

AVOID AND REPORT RECRUITMENT SCAMS

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.