Director of Quality, Risk Management and Compliance  

POSITION SUMMARY:

APLA Health & Wellness (APLAHW) is seeking a qualified individual to provide leadership and expertise to ensure the delivery of safe, high quality patient care services delivered at all clinical sites. APLAHW provides culturally competent medical, dental and behavioral health services to low-income individuals in Los Angeles County, with a specific focus on  the LGBT community.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Oversees a corporate wide quality improvement program inclusive of all staff, maintains a written quality improvement plan and annual evaluation of the plan’s effectiveness.

• In collaboration with the Medical Director, develops and maintains a performance measurement work plan and reporting calendar to ensure timely data collection, aggregation, analysis, and reporting of established quality  measures related to key operational and clinical processes and outcomes.

• Under the medical director, facilitate the monthly Quality, Risk Management and Compliance meeting.

• Provides guidance in the transition of APLAHW to become a patient-centered medical home per National Committee for Quality Assurance (NCQA) standards.

• Oversees electronic storage of quality improvement reports to promote ongoing access for key stakeholders.

• In coordination with the medical director and COO, oversees 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..

• In consultation with the Medical Director and CEO, submits mandatory notification of known or suspected corporate compliance violations to the appropriate regulatory agencies.

• Oversees a corporate wide risk management program, develops and maintains a written corporate risk management plan and annual evaluation of the plans’ effectiveness.

• Develop and maintain policies and protocols supporting the risk management plan.

• Oversees, and develops as needed, processes for internal incident reporting, investigates and evaluates claims and potential claims.

• Oversees a Clinic wide patient safety program, develops and maintains a written patient safety plan and annual evaluation of the plan’s effectiveness and develops and maintains policies and procedures related to the patient safety program.

• Collaborates with the Medical Director in 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 Medical Director.

• Develops plans for and ensures all employees participate in training that will create greater awareness and meet all compliance requirements.

• Acts as Privacy Officer for the clinics.

• Supervises the Quality Improvement Supervisor and the Risk & Compliance Supervisor

• Oversee efforts to ensure that documentation captured accurately reflects services performed and complexity of care in order to maximize health plan and IPA reimbursements available.

• Oversee the development, execution, and evaluation of agency continuous quality improvement, peer review, and utilization management efforts.

• Oversee an annual risk assessment

• Represents APLA Health as the Senior Quality, Risk and Compliance management  staff at various community associations and meetings, including CCALAC, CPCA, and others as appropriate.

   

  OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

   

REQUIREMENTS:

Training and Experience:

Possession of the following required: Master’s Degree in Nursing, Public Health or Healthcare Administration from an accredited college or university. Prior administrative and supervisory experience in an outpatient family practice, internal medicine, or a Federally Qualified Health Center or community clinic. Experience leading quality improvement teams. Demonstrated ability to perform assigned responsibilities with minimum supervision; to maintain quality control standards; to interpret, adapt and apply guidelines and procedures. Strong verbal, written and interpersonal skills. Ability to develop and maintain cooperative relationships with staff members, patients and clinicians and work as a member of a multi-disciplinary team. Demonstrated ability to follow set routines and be alert to variations and make decisions accordingly. Sensitivity to racially, ethnically, culturally and sexually diverse populations; excellent oral and written communication skills; and knowledge of Microsoft Office. Experience with electronic health records, Must possess current CPR certification.

Knowledge of:

Working knowledge of management methods and practices in a community clinic setting or similar health care facility. Experience in developing QM and Compliance  programs;. Basic knowledge of local, state and federal regulations relating to care of patients in a clinic setting, Managed Care, and Title 22 is preferred Skill in identifying problems and recommending solutions in a clear, concise and proactive manner, including recognition and resolution of costly errors.  Demonstrated ability to set priorities and organize work responsibilities to insure completion of assigned tasks within agreed upon time span. Knowledge of common safety hazards and precautions sufficient to establish a safe work environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

SPECIAL REQUIREMENTS:

Must possess a valid California driver’s license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes.

APLA Health is an Equal Opportunity Employer.

To Apply:

Visit our website at www.aplahealth.org  to apply or click the link below:

https://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=34929&clientkey=A5559163F67395E0A2585D2135F98806

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