Job description

The Director of Quality & Compliance is a member of the Quality & Compliance Department as well as participates as a member of the Sr. Leader Team who reports to the Chief Executive Officer for overall supervision and quality concerns. The Director of Quality & Compliance also reports all compliance issues directly to the Chief Executive Officer. This position contributes to the fulfillment of the organization’s mission and vision by performing quality & compliance audits and monitoring essential services in compliance with federal and state regulations, federal compliance guidelines and accreditation standards.

This position directs employees in quality and regulatory compliance, maintains the effectiveness of the Corporate Compliance program; serves as the primary compliance resource for Medicaid/Medicare reimbursement information, and maintains compliance with reimbursement and regulatory standards and regulatory issues.

BASIC JOB DUTIES INCLUDE:

1. Performs organization wide, program and department audits to investigate and monitor compliance with federal and state laws and regulations, Medicare and Medicaid laws and regulations, current coding and billing guidelines and the HIPAA Privacy Standards.

2. Provides professional education on corporate responsibility, ethical principles, and service recovery.

3. Responsible for the overall risk management of the organization focusing on high risk, problem prone areas.

4. Actively participates in the quality and compliance committees.

5. Works closely with the Chief Clinical Officer/Director of Clinical Services to ensure corrective actions are implemented to prevent and/or correct any discrepancies in billing to Medicare, Medi-Cal or commercial payors.

6. Oversees the quality and medical records departments.

7. Establishes and maintains a mechanism to track access to protected health information.

8. Responsible for the overall monitoring & tracking of infection control in patient care delivery.

9. Responsible for the documentation and tracking of the service recovery process and handling of complaints with the assistance of clinical services.

10. Liaison for the Board Quality and Compliance Committee.

11. Ensures all hospice quality and compliance audits are completed annually and as needed to maintain compliance with the Conditions of Participation and accreditation standards.

12. Performs other duties as assigned.

LEADERSHIP:

1. Serves as an active and contributing senior leader member and effectively collaborates with colleagues.

2. Inspirational and effective management skill to mentor and motivate staff, leverage existing capacity, delegate appropriately, and strengthen performance while maintaining best practices, camaraderie, and shared accountability.

3. Creates a work environment which encourages participation in order to promote retention, productivity, and a quality, customer-oriented staff; and utilizes clearly defined goals, objectives, and methods with which to measure success.

4. Takes action to enforce rules; confronts others about problems when necessary.

5. Empower others by sharing responsibility to encourage a deep sense of commitment and ownership.

6. Demonstrates creativity and innovation. Takes reasonable risks and accepts full accountability for actions taken.

7. Allow subordinates to take reasonable risks and accept accountability for their actions.

8. Develops a spirit of cooperation and teamwork while leading a group of people.

9. Works for solutions that generally benefit all involved parties.

10. Demonstrates self-confidence, positive image and ability to think conceptually in leading and directing others.

11. Recognizes complex connections in situation and is able to identify the key or underlying issues.

12. Demonstrates the ability to make decisions independently that benefit the agency as a whole based on the identification of key or underlying issues.

QUALIFICATIONS:

1. Bachelors of Science in Nursing (BSN) required or an equivalent Bachelors related to position, Masters of Science in Nursing (MSN) preferred.

2. HCCA certification in Healthcare Compliance and Privacy preferred.

3. Minimum of 5 years of healthcare leadership and/or quality assurance/compliance experience. Experience in healthcare compliance regulations required.

4. Experience or familiarity with audit construction.

5. Experience working with time sensitive, confidential projects.

6. Working knowledge of compliance activity plans and Corporate Compliance required elements.

7. Demonstrated success in strategic planning and implementation of tactics to achieve goals, along with the success in managing the work efforts of others. Ability to align the department’s objectives with that of other senior leaders so the agency grows and prospers in a harmonious, team oriented manner.

8. Innovative problem-solving abilities.

9. Excellent organizational, time management, and communication skills.

10. Working knowledge of MS Office Suite.

11. Current California driver’s license and proof of insurance required.

Job Type: Full-time

Pay: $140,896.00 - $155,069.14 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Ability to commute/relocate:

• Escondido, CA 92025: Reliably commute or willing to relocate with an employer-provided relocation package (Required)

Education:

• Bachelor's (Required)

Experience:

• Compliance management: 3 years (Required)
• Healthcare: 5 years (Required)

License/Certification:

• RN License (Required)

Work Location: In person

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