Avow, Inc.
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DIRECTOR OF QUALITY AND COMPLIANCE
role at
Avow, Inc. 2 days ago Be among the first 25 applicants Join to apply for the
DIRECTOR OF QUALITY AND COMPLIANCE
role at
Avow, Inc. The Director of Compliance and Quality is a healthcare leader who plays a crucial leadership role within our organization, focusing on two key areas: ensuring adherence to regulatory standards (compliance) and improving the quality of patient care (quality improvement).
Before applying for this role, please read the following information about this opportunity found below.
Job Summary
Detects and evaluates risks. Ensures that risks are minimized by following-up and acting on regulatory survey report recommendations/deficiencies in collaboration with the other departments. Under the direction of the CO implements, oversees and manages the corporate compliance program(s). Keeps current with and communicates relevant information from the Office of the Inspector General (OIG), Florida Agency for Healthcare Administration (AHCA) regulations, fraud alerts and advisory opinions. Assists the organizations leaders to resolve compliance issues in a timely manner to avoid any incidence of potential fraud, abuse, waste or neglect. Keeps current with and communicates relevant information from the Office of the Inspector General (OIG), Florida Agency for Healthcare Administration (AHCA) regulations, fraud alerts and advisory opinions. Ensures that the organization’s Quality, Compliance and Ethics Programs are updated regularly as needed, provides for training for Board, volunteers and staff on the program(s) and that the program(s) is/are always in accordance with current law, regulations and best practices. Plans and manages Avow’s compliance and audit program(s) in accordance with directives and priorities of the CO. Encourages all employees, volunteers and direct patient care contractors to report any suspected compliance or ethical breaches for investigation without fear of retaliation. Investigates all reports and presents findings to appropriate parties. In collaboration with the CO, utilizes external resources such as regulatory attorneys and compliance consultants to assist with guidance related to follow up on reported issues. Tracks in compliance tracking logs. Reads, analyzes, summarizes, reports and recommends to organizational leaders any proposed and new federal and state regulations and Joint Commission standards and other pertinent specialty accreditation requirements to provide direction for the company response. Maintain a working knowledge of current and proposed laws, regulations and guidelines. Reviews compliance activities and collaborates with the clinical operations leaders, in developing action plans for areas identified as non-compliant. Serves as a key contact person to leaders responsible for compliance and assigned standards and other regulatory requirements. Under the direction of the CO conducts, on a regular basis, conducts the Enterprise Risk Management and Compliance Enterprise Risk Management process with the Executive Leadership Team and Compliance committee. Designs and implements annual Audit plan(s) for the organization in conjunction with the operations leaders to focus on areas of concern or priority elicited from previous audits, compliance concern reports/investigations, OIG Work Plan, ERM Tools, staff education and documentation learning need trends, new regulations and high risk areas. Reports trends, high risk areas and action plans and adjusts the audit plan on an ongoing basis as needed to the CO and CEO. Manages the organization’s Compliance Committee. Identifies high-risk areas to reduce the agencies vulnerability to fraud and abuse. Monitors the organizations PEPPER report and NCLOS rates reporting results to the CEO and CO. Identifies and monitors developments and trends in internal operations and external regulatory environments to assess risk and compliance impacts and implements best compliance practices. Under the direction of the CO, responsible for ensuring processes are in place to monitor and evaluate safety and risk management. Implements corrective action plans for resolution of problematic areas and provides general guidance on how to avoid, mitigate, or address similar situations. Maintains updated knowledge and expertise in health information record management, documentation requirements for all clinical disciplines and external collaborative practitioners such as referring physicians, long term care facilities, hospitals, etc. Fosters collaboration with IT department and external parties’ electronic records systems to enable integration, improve information sharing and maintain patient information privacy standards Provides expert clinical resource in health information coding to maximize compliance with documentation requirements and billing capacity and compliance with third party payers. Provides for collaboration with Billing, Service Integrity and IT departments and documentation consultants to ensure best practices related to clinical documentation are being implemented. Provides back up support to the CO and Service Integrity Team. Serves on various committees Supervises the HIM supervisor maintaining oversite of HIM and providing health information records management and support Ensures the collection of data and maintenance of the physician license verification database and directs performance audits to assess compliance with licensing requirements Ensures the ongoing maintenance of HIM tracking databases for compliance with regulatory and legal requirements Initiates or participates in the development of medical records systems or new processes that reflect increased efficiency, productivity and/or quality in Health Information Management Maintains tracking system for Medicare or other insurance audits through all systems of appeals Develops and implements new processes that reflect increased efficiency and productivity throughout departments Facilitates the activities of on-site and remote auditors, surveyors and consultants to ensure they receive requested information and follow up Maintains regulatory and legal requirements related to health information and communication within the organization Ensures the maintenance of data integrity, tracking and reporting to support clinical and organizational processes Tracks and monitors statistical data, quality indicators and maintains reports that support standards of care and program management Stays up to date on Hospice Quality Reporting Programs (HQRP). Ensures that the HQRP requirements are met. Working with the Service Integrity Team and Organization, develops and implement programs and initiatives centered on best practice standards, patient rating, feedback reporting, and customer service. Under the direction of the CO, oversees the organizations quality improvement programs (QAPI) ensuring quarterly QPAI meetings are effectively held, updates annual QAPI plans and accurately completes annual reports. Maintains knowledge of The Office of Civil Rights (OCR) HIPAA requirements and may serve as the organizations privacy officer. Oversees the organization’s complaint management system and ensures that complaints are tracked and followed up on appropriately. Ensures that all compliance related government audits are responded to fully and timely. All other duties as assigned
Qualifications
Computer Skills:
Proficient typing skills, data entry and word processing software, database software, excel, knowledge of e-mail.
Supervisory Responsibilities:
Under the direction of the Compliance Officer, this position oversees the Avow Quality and Avow Compliance Plans for all clinical service lines. Direct oversight of department staff and programs may include Medical Records (HIM), Quality, Compliance, Coding, Informatics, Education, Survey Readiness and Operation Support.
Education/Experience:
Bachelor's degree (B.A.) from four-year university is required. Master’s degree in applicable business or clinical area is preferred but not required. Experience in compliance including external and internal auditing, compliance program management. Working knowledge of hospice regulations, AHCA regulations and The Joint Commission Standards. Must have exceptional customer services skills to include service recovery and conflict resolution aptitude.
Certificates, Licenses, Registrations
Current Florida Driver's License. Certification in Health Care Compliance (CHC) required within one year.
Certification in Health Care Privacy Compliance (CHPC), licensed Healthcare Risk Manager, and medical coding certification preferred. Registered Nurse in Florida is preferred.Seniority level
Seniority levelDirector Employment type
Employment typeOther Job function
Job functionQuality Assurance IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Avow, Inc. by 2x Sign in to set job alerts for “Director of Quality” roles. Naples, FL $80,000.00-$110,000.00 4 weeks ago Marco Island, FL $25.02-$29.81 8 hours ago Manager Professional Practice & Clinical Education We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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DIRECTOR OF QUALITY AND COMPLIANCE
role at
Avow, Inc. 2 days ago Be among the first 25 applicants Join to apply for the
DIRECTOR OF QUALITY AND COMPLIANCE
role at
Avow, Inc. The Director of Compliance and Quality is a healthcare leader who plays a crucial leadership role within our organization, focusing on two key areas: ensuring adherence to regulatory standards (compliance) and improving the quality of patient care (quality improvement).
Before applying for this role, please read the following information about this opportunity found below.
Job Summary
Detects and evaluates risks. Ensures that risks are minimized by following-up and acting on regulatory survey report recommendations/deficiencies in collaboration with the other departments. Under the direction of the CO implements, oversees and manages the corporate compliance program(s). Keeps current with and communicates relevant information from the Office of the Inspector General (OIG), Florida Agency for Healthcare Administration (AHCA) regulations, fraud alerts and advisory opinions. Assists the organizations leaders to resolve compliance issues in a timely manner to avoid any incidence of potential fraud, abuse, waste or neglect. Keeps current with and communicates relevant information from the Office of the Inspector General (OIG), Florida Agency for Healthcare Administration (AHCA) regulations, fraud alerts and advisory opinions. Ensures that the organization’s Quality, Compliance and Ethics Programs are updated regularly as needed, provides for training for Board, volunteers and staff on the program(s) and that the program(s) is/are always in accordance with current law, regulations and best practices. Plans and manages Avow’s compliance and audit program(s) in accordance with directives and priorities of the CO. Encourages all employees, volunteers and direct patient care contractors to report any suspected compliance or ethical breaches for investigation without fear of retaliation. Investigates all reports and presents findings to appropriate parties. In collaboration with the CO, utilizes external resources such as regulatory attorneys and compliance consultants to assist with guidance related to follow up on reported issues. Tracks in compliance tracking logs. Reads, analyzes, summarizes, reports and recommends to organizational leaders any proposed and new federal and state regulations and Joint Commission standards and other pertinent specialty accreditation requirements to provide direction for the company response. Maintain a working knowledge of current and proposed laws, regulations and guidelines. Reviews compliance activities and collaborates with the clinical operations leaders, in developing action plans for areas identified as non-compliant. Serves as a key contact person to leaders responsible for compliance and assigned standards and other regulatory requirements. Under the direction of the CO conducts, on a regular basis, conducts the Enterprise Risk Management and Compliance Enterprise Risk Management process with the Executive Leadership Team and Compliance committee. Designs and implements annual Audit plan(s) for the organization in conjunction with the operations leaders to focus on areas of concern or priority elicited from previous audits, compliance concern reports/investigations, OIG Work Plan, ERM Tools, staff education and documentation learning need trends, new regulations and high risk areas. Reports trends, high risk areas and action plans and adjusts the audit plan on an ongoing basis as needed to the CO and CEO. Manages the organization’s Compliance Committee. Identifies high-risk areas to reduce the agencies vulnerability to fraud and abuse. Monitors the organizations PEPPER report and NCLOS rates reporting results to the CEO and CO. Identifies and monitors developments and trends in internal operations and external regulatory environments to assess risk and compliance impacts and implements best compliance practices. Under the direction of the CO, responsible for ensuring processes are in place to monitor and evaluate safety and risk management. Implements corrective action plans for resolution of problematic areas and provides general guidance on how to avoid, mitigate, or address similar situations. Maintains updated knowledge and expertise in health information record management, documentation requirements for all clinical disciplines and external collaborative practitioners such as referring physicians, long term care facilities, hospitals, etc. Fosters collaboration with IT department and external parties’ electronic records systems to enable integration, improve information sharing and maintain patient information privacy standards Provides expert clinical resource in health information coding to maximize compliance with documentation requirements and billing capacity and compliance with third party payers. Provides for collaboration with Billing, Service Integrity and IT departments and documentation consultants to ensure best practices related to clinical documentation are being implemented. Provides back up support to the CO and Service Integrity Team. Serves on various committees Supervises the HIM supervisor maintaining oversite of HIM and providing health information records management and support Ensures the collection of data and maintenance of the physician license verification database and directs performance audits to assess compliance with licensing requirements Ensures the ongoing maintenance of HIM tracking databases for compliance with regulatory and legal requirements Initiates or participates in the development of medical records systems or new processes that reflect increased efficiency, productivity and/or quality in Health Information Management Maintains tracking system for Medicare or other insurance audits through all systems of appeals Develops and implements new processes that reflect increased efficiency and productivity throughout departments Facilitates the activities of on-site and remote auditors, surveyors and consultants to ensure they receive requested information and follow up Maintains regulatory and legal requirements related to health information and communication within the organization Ensures the maintenance of data integrity, tracking and reporting to support clinical and organizational processes Tracks and monitors statistical data, quality indicators and maintains reports that support standards of care and program management Stays up to date on Hospice Quality Reporting Programs (HQRP). Ensures that the HQRP requirements are met. Working with the Service Integrity Team and Organization, develops and implement programs and initiatives centered on best practice standards, patient rating, feedback reporting, and customer service. Under the direction of the CO, oversees the organizations quality improvement programs (QAPI) ensuring quarterly QPAI meetings are effectively held, updates annual QAPI plans and accurately completes annual reports. Maintains knowledge of The Office of Civil Rights (OCR) HIPAA requirements and may serve as the organizations privacy officer. Oversees the organization’s complaint management system and ensures that complaints are tracked and followed up on appropriately. Ensures that all compliance related government audits are responded to fully and timely. All other duties as assigned
Qualifications
Computer Skills:
Proficient typing skills, data entry and word processing software, database software, excel, knowledge of e-mail.
Supervisory Responsibilities:
Under the direction of the Compliance Officer, this position oversees the Avow Quality and Avow Compliance Plans for all clinical service lines. Direct oversight of department staff and programs may include Medical Records (HIM), Quality, Compliance, Coding, Informatics, Education, Survey Readiness and Operation Support.
Education/Experience:
Bachelor's degree (B.A.) from four-year university is required. Master’s degree in applicable business or clinical area is preferred but not required. Experience in compliance including external and internal auditing, compliance program management. Working knowledge of hospice regulations, AHCA regulations and The Joint Commission Standards. Must have exceptional customer services skills to include service recovery and conflict resolution aptitude.
Certificates, Licenses, Registrations
Current Florida Driver's License. Certification in Health Care Compliance (CHC) required within one year.
Certification in Health Care Privacy Compliance (CHPC), licensed Healthcare Risk Manager, and medical coding certification preferred. Registered Nurse in Florida is preferred.Seniority level
Seniority levelDirector Employment type
Employment typeOther Job function
Job functionQuality Assurance IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Avow, Inc. by 2x Sign in to set job alerts for “Director of Quality” roles. Naples, FL $80,000.00-$110,000.00 4 weeks ago Marco Island, FL $25.02-$29.81 8 hours ago Manager Professional Practice & Clinical Education We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr