Compliance Manager

3 weeks ago

Washington, United States Children's National Hospital Full time

The Compliance Manager will assist and support the Chief Compliance and Privacy Officer with the compliance functions of the organization to include (1) clinical compliance (2) compliance training and communications (3) auditing and monitoring through the performance of proactive auditing and monitoring of patient encounters, medical record documentation and quality metrics (4) compliance investigations and resolutions plans relating to clinical performance (4) compliance risk and controls framework, including the design and implementation of key risk indicators, tools and systems, processes and controls (5) and sanction screening. The Compliance Manager will be responsible for daily operational functions of the core elements of the organization's compliance functions and work with Compliance Office on matters needing escalation and resolution. Compliance Manager will also assist the Compliance Officer in preparing for the (1) Compliance Management Committee and (2) Board Enterprise Risk, Compliance, and Legal Affairs (ERCLA) Committee. The Compliance Manager will need to be able to interface cross-functionally across the organization, especially by providing compliance support to the audit and monitoring team within Revenue Cycle Management.

Qualifications:
Minimum Education
BSN Undergraduate or professional degree in nursing or related specialty preferred (Required)

Minimum Work Experience
10 years At least five years' experience in healthcare operations or equivalent experience. (Required)

Functional Accountabilities
Clinical Compliance

  • Maintain a working knowledge of relevant laws, rules, and regulations governing the healthcare services and clinical practice furnished by Children's National clinicians and hospital.
  • Stay current on relevant industry and government clinical compliance program guidance, investigations, and audit; stay abreast of and provides updates regarding changes in legislation, regulations and other requirements that may result in organizational response.
  • Provide management of clinical compliance, quality and standards projects within Clinical Operations; prepares key performance indicators.
  • Develop initial interpretation of relevant regulations and guidelines and act as a the subject matter expert (SME)for Clinical Operations.
  • Serve as the subject matter expert in clinical compliance and respond to questions, concerns, and provide guidance.
  • Support the development and management of the research compliance program.
  • Develop expertise and perform research in compliance and issues as requested.
  • Assist clinical teams with inspections, audit responses and consult on root cause analysis, as required.
  • Coordinate implementation of overall Compliance Plan and Code of Conduct; consult and provide guidance on a regular basis on related issues with operations directors/managers to ensure conformance with applicable laws and regulations.
  • Develop presentations for the Compliance Management Committee and work groups.
  • Assist in periodic reviews and revisions of the Compliance policies and procedures.
  • Assist the Vice President of Compliance with other department activities, as assigned.
Internal Investigations & Reviews
  • Perform and document internal investigations in accordance with applicable legal requirements and organizational policies and procedures.
  • Investigate incidents, document findings, oversee completion of corrective actions plans.
Compliance Education & Training
  • Support the compliance training programs on a day-to-day basis, ensuring timely completion of on-boarding and topic specific training and education by the workforce.
  • Research and author educational materials.
  • Provide compliance educational and training offerings.
  • In partnership with the Legal Department, serve as a subject matter resource and provide consultation services regarding the application and implementation of current legal requirements and organizational policies and procedures.
Auditing & Monitoring
  • Identification of clinical focus areas by the OIG and other regulatory bodies to assist in forming the compliance audit and monitoring work plan.
  • Development and implementation of clinical risk assessments and audits; capture and monitor corrective action plans until resolution.
  • Perform clinical compliance risk assessments, including development and completion of action plans to address findings.
  • Assist with auditing and monitoring to ensure compliance with all federal, state & local regulations, as well as fiduciary requirements, and identify areas of vulnerability and risk.
Organizational Accountabilities
Organizational Commitment/Identification
  • Partner in the mission and upholds the core principles of the organization.
  • Commitment to diversity and recognize value of cultural/ ethnic differences.
  • Demonstrate personal and professional integrity.
  • Maintain confidentiality at all times.
Customer Service
  • Anticipate and respond to customer needs; follow up until needs are met.
Teamwork/Communication
  • Demonstrate collaborative and respectful behavior.
  • Partner with all team members to achieve goals.
  • Receptive to others' ideas and opinions.
Performance Improvement/Problem-solving
  • Contribute to a positive work environment.
  • Demonstrate flexibility and willingness to change.
  • Identify opportunities to improve clinical and administrative processes.
  • Make appropriate decisions, using sound judgment.
Cost Management/Financial Responsibility
  • Use resources efficiently.
  • Search for less costly ways of doing things.
Safety
  • Speak up when team members appear to exhibit unsafe behavior or performance.
  • Continuously validate and verify information needed for decision making or documentation.
  • Stop in the face of uncertainty and takes time to resolve the situation.
  • Demonstrate accurate, clear and timely verbal and written communication.
  • Actively promote safety for patients, families, visitors and co-workers.
  • Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance.
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
  • Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication
  • Demonstrate collaborative and respectful behavior
  • Partner with all team members to achieve goals
  • Receptive to others' ideas and opinions
Performance Improvement/Problem-solving
  • Contribute to a positive work environment
  • Demonstrate flexibility and willingness to change
  • Identify opportunities to improve clinical and administrative processes
  • Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
  • Use resources efficiently
  • Search for less costly ways of doing things
Safety
  • Speak up when team members appear to exhibit unsafe behavior or performance
  • Continuously validate and verify information needed for decision making or documentation
  • Stop in the face of uncertainty and takes time to resolve the situation
  • Demonstrate accurate, clear and timely verbal and written communication
  • Actively promote safety for patients, families, visitors and co-workers
  • Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

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