Rn Compliance Manager
3 weeks ago
**About us**:
Saint James Health is a growing community health center located in the East Ward, West Ward, and South Ward of Newark, NJ. Our goal is to provide comprehensive primary care to the community in a setting that is comfortable and accommodating to all the visitors of Saint James Health. The health of oneself and their family is our top priority.
**Position Summary**:
The Compliance Officer oversees the corporate compliance program for Saint James Health providing direction, oversite, and advice for compliance: this will involve all clinical, program and administrative departments. It is the responsibility of the Compliance Officer for ensuring compliance with standards issued by accrediting organizations, state licensure requirements, federal regulations, and grant specific conditions. The Compliance Officer reports to the Chief Executive Officer.
**Responsibilities**:
- Oversees and implements Saint James Health corporate compliance program adopted by the Board and approved by the CEO.
- Ensures Saint James Health nonprofit services and funding are in compliance with all federal, state, and city regulations, certifications, and licensing requirements.
- Implements and maintains policies that prevent illegal, unethical, and improper conduct.
- Monitors compliance for FTCA (Federal Tort Claims Act) to ensure compliance and readiness for audits.
- Assesses regulations and standards (NCQA, CMS, HRSA and State) and assures appropriate controls are in place, making recommendations and overseeing implementation of new controls where necessary
- Assures that clinical staff are documenting appropriately in medical management system so that member letters are clear, understandable, and meet regulatory requirements
- Reviews, as appropriate, all documents relevant to compliance matters, such as 340b prescription drug program, billing records, contracts, referrals, and payment agreements.
- Advises the CEO of all compliance assessments and ensures readiness for external audits.
- Regularly establishes criteria to determine and measure compliance objectives established by the Board and CEO.
- Coordinates education and training program for Saint James Health corporate compliance objectives, and ensure all staff comply with the Board and CEO's directives.
- Develops and maintains ongoing relationships with Saint James Health employees to ensure appropriate communication, interaction, and cooperation in achieving compliance objectives.
- Ensures that independent contractors, vendors and agents contracted with Saint James Health comply with applicable Federal and State compliance requirements, including but not limited to, healthcare coding and billing requirements.
- Conducts, where necessary, effective internal investigations as directed by the CEO to detect improper conduct, and reports results to the CEO as appropriate.
- Coordinates responses to external investigations in conjunction with the CEO and assigned Legal Counsel.
**Other Duties**:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
**Qualifications**:
To perform this job successfully, an individual must be able to perform each essential duty 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.
- LPN's with compliance experience considered as well
- Active NJ Licensed Registered Nurse
- Knowledge of utilization review processes and utilization management systems, moderate to strong knowledge of Epic
- Experience adhering to NCQA, CMS and other programs requiring regulatory compliance
- A minimum of five (3) years of experience in medical practice operations, planning, finance, or healthcare law, inclusive of at least three (2) years of managerial experience, is required.
- Experience dealing with compliance and investigations is required.
- Strong leadership abilities, and excellent written and oral communication skills are required.
- A strong sense of integrity and excellent analytical skills are required and the ability to function in a collaborative team environment required.
- Proficient in Microsoft Word, Excel and experience with reporting from Electronic Medical Record Systems
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