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Compliance/Privacy and Risk Officer

1 month ago

Rocky Mount, United States UNC Health Care Full time

Description Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. UNC Health Nash, an affiliated member of the UNC Health system, invites passionate healthcare professionals to join our esteemed team. Governed locally, we proudly serve a diverse patient base, spanning Nash, Edgecombe, Halifax, Wilson Counties, and beyond. With a steadfast commitment to elevating community health through exceptional care, we prioritize excellence, compassion, and innovation, ensuring every individual receives the highest standard of support. Joining our team means becoming an integral part of our dedication to wellness, where we constantly strive to redefine excellence in healthcare through state-of-the-art facilities and pioneering programs. Join us in this transformative journey, where your contributions will make a lasting impact on our community's health and wellbeing. Summary: The Compliance/Privacy and Risk Management Manager is responsible for development and implementation of the compliance and risk management program which includes the procurement of professional and general liability insurance coverage and risk financing, clinical loss prevention, risk identification and evaluation, claims management, and litigation management. Duties also include incident investigation, analysis, tracking, trending and evaluation. Compliance and Privacy oversight entails employee training sessions, investigation and response to compliance, privacy or risk-related inquiries received from any employees, implementation of internal audits, oversight of compliance-related audits by outside agencies, annual reports to the Board of Commissioners and any other function necessary to ensure that the Corporate Compliance Program meets its objectives. Responsibilities: Proactively evaluates areas of organizational risk, based on internal assessment and external benchmarking. Recommends implementation of strategies and policies which promote patient, visitor, volunteer, and employee safety. Assists in overseeing the occurrence reporting system as well as identifies, investigates, and evaluates occurrences. Helps develop strategies for management of serious adverse events. Identifies, investigates, and evaluates grievances related to Section 1557 of the Patient Protection and Affordable Care Act of 2010. Ensures meaningful communication regarding medical conditions, treatment, and billing with Limited English Proficiency patients and patients with communication disabilities (for example, patients who are sight, hearing and/or speech impaired). Oversees the contract management software system and consults with outside counsel as needed on contract issues. Develops and administers the Loss Prevention program to protect the assets of the corporation. Responsible for obtaining, managing, and coordinating professional, liability, and property insurance coverage. Manages claims against the corporation. Develops case management plans defining key participants and steps in resolving claims. Defines issues involved in the case and makes recommendations for settlement strategies. Serves as liaison between organizational attorneys and patient attorneys. Assists in negotiating and settling claims in a manner that protects the fiduciary interest of the organization. Assists in the analysis of intensive analysis of sentinel and near-miss events. Assists in the resolution and implementation of strategies, policies, and procedures. Plans, develops, and presents educational sessions with organizational teammates and medical staff regarding loss prevention and reduction techniques, insurance coverages and exclusions, medical record documentation, legal issues and communication techniques. Provides risk management advice to teammates and leadership regarding incidents that have occurred or issues that are anticipated. Performs special projects that involve data gathering, analysis, preparation of reports, development of recommendations and presentations. Collaborates with the Executive Director of Quality to investigate medical circumstances and legal implications of incidents and claims. Review medical records, protocols, laws, policies and procedures governing the alleged liability claim. Interviews employees, patient, patient family members, and others who are involved with the incident and claim, and provides guidance to leadership on mitigating risk. Leads people toward meeting the corporation's vision, mission, and goals as related to patient safety, risk management, and loss prevention. Collaborates with others to drive change. Establishes and implements an effective compliance program to prevent illegal, unethical, or improper conduct. Collaborates with Human Resources and senior leadership to determine appropriate path for investigation and handling of potential code of conduct violations. Develop, implement, oversee, and monitor a comprehensive compliance program that encompasses the hospital, physician practices, and other off-site locations. This includes but is not limited to drafting and updating compliance policies and procedures and if needed, distributing the Code of Conduct to provide guidelines for compliant and ethical business decision-making and behavior; promoting reporting of potential compliance and privacy concerns including raising awareness of the Compliance & Privacy Hotline; preparing quarterly reports to the Board; serving as the Chairperson for the Compliance Committee; annually evaluating the effectiveness of the compliance program;; investigating compliance issues; developing, implementing, and presenting compliance/privacy education and training modules/presentations for the workforce; and developing and implementing a monitoring/audit work plan to address high risk areas. Perform day-to-day operations of the compliance and privacy programs using full authority to access any and all documents that are relevant to compliance/privacy activities. Collaborate with other departments (i.e., Patient Experience, Human Resources, Security, Health Information Management, Nursing, Quality, Revenue Cycle, etc.) to address and resolve compliance and privacy concerns. Consult with outside legal counsel as needed to resolve difficult legal compliance issues. Coordinate audits/investigations by external agencies (i.e., OCR, Palmetto GBA, etc.) and submit corrective action plans as required to demonstrate compliance. Stay abreast of current healthcare laws and regulations, and changes that may affect the organization. Identify potential areas of compliance and HIPAA/Privacy vulnerability and risk, develop and implement corrective action plans for resolution of problematic issues, and provide general guidance on how to avoid or address similar situations in the future. Responsible for the organization's Privacy Program including but not limited to daily operations of the program; development, implementation, and maintenance of privacy policies and procedures; monitoring privacy program compliance; investigation and tracking of privacy incidents and breaches; and insuring patients' privacy rights in compliance with federal and state laws. Collaborate with UNC Health Care Audit, Compliance, and Privacy Services to facilitate a system-wide approach to compliance and privacy. This includes but is not limited to serving as the representative on the Compliance Council, Privacy Committee, and Privacy Work Group. Other Information: Education Requirements: Bachelor’s degree required in nursing, patient care, public policy, health care administration, or other related discipline of study. Master’s degree, or terminal degree, preferred. Licensure/Certification Requirements: Terminal professional degree preferred (JD, MRA, MS ERM, etc.), or; Certified Professional in Healthcare Risk Management (CPHRM) or Certified Professional in Healthcare Quality (CPHQ). If no certification, must obtain certification within three years of hire. Professional Experience Requirements: At least three (3) years’ experience in nursing, risk management, performance improvement (quality) or professional liability claims management. Additional Specialized Knowledge/Skills: Customer Focus, Interpersonal Skills Exceptional relationship building and networking skills. Knows how to effectively partner with medical staff and others to improve quality of care. Outstanding communication skills. Can express opinions openly and non-defensively. o Approachable. Visible leader. Demonstrates tact and diplomacy when addressing issues. Able to address multiple and /or unexpected issues/demands with confidence and balance. Organizational Skills o Can provide leadership and guidance on multiple activities at once. Ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity. Exhibits ability to make timely and appropriate decisions. o Excellent analytical and problem-solving skills. o Strong attention to detail and accuracy. o Anticipates future consequences and trends. · Accountability o Strong work ethic, unquestionable integrity and character. Self-directed, results oriented. Business Acumen o Demonstrate financial, operational, and technical savvy in driving and promoting quality and cost-effective patient care. Proficient with MS Office and able to learn new software rapidly. Job Details Legal Employer: Nash Hospitals Entity: Nash UNC Health Care Organization Unit: NGH Nhi Administration Work Type: Full Time Standard Hours Per Week: 40.00 Work Assignment Type: Onsite Work Schedule: Day Job Location of Job: NASH HC Exempt From Overtime: Exempt: Yes Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.