Chief Risk and Compliance Officer

2 weeks ago

East Orange, New Jersey, United States CareWell Health Full time
Position Overview

The Chief Risk and Compliance Officer plays a pivotal role in overseeing the risk management initiatives within the organization. This includes a comprehensive understanding of insurance protocols, assisting with claims and losses, collaborating with legal advisors, and managing the daily operations of the risk management framework. The individual will be responsible for analyzing risk management metrics, conducting educational programs, spearheading projects aimed at minimizing losses and enhancing patient safety, and ensuring adherence to the standards set forth by accreditation bodies. Additionally, this role encompasses the development and execution of the CareWell Health Compliance Program, ensuring compliance with all relevant laws and regulations pertaining to healthcare operations.

Key Responsibilities:
  • Uphold the mission of CareWell Health by striving for excellence in healthcare delivery through a commitment to quality and compassionate service.
  • Engage in policy formulation and organizational improvements.
  • Demonstrate exceptional collaboration skills across various departments, managing projects from conception to execution.
Risk Management Duties:
  • Serve as a subject matter expert in risk management, providing consultation to both internal and external stakeholders.
  • Prioritize risk mitigation, patient safety, and loss prevention while working with colleagues to maintain a secure environment for patients and staff.
  • Collaborate with clinical and administrative leaders to understand the intricate dynamics between root causes, clinical outcomes, and hospital performance.
  • Address urgent risk scenarios requiring immediate attention and action.
  • Work alongside clinical leadership on peer reviews and quality management initiatives.
  • Coordinate with quality teams and stakeholders to address complaints and ensure compliance with regulatory standards.
Compliance Oversight:
  • Lead the development and implementation of the CareWell Health compliance framework.
  • Design and modify written policies and procedures related to compliance.
  • Act as a collaborative partner in responding to significant incidents, ensuring thorough investigations and corrective actions.
  • Oversee daily operations of the compliance department, including organizing compliance committee meetings.
  • Ensure timely and accurate preparation of compliance reports for management review.
  • Facilitate educational sessions on compliance, privacy, and ethics for all organizational levels.
  • Stay informed on legal and regulatory changes affecting operations, providing management with insights on trends and best practices.
  • Manage an anonymous reporting system for employees to report compliance concerns.
  • Work with Human Resources and other departments to enforce disciplinary measures for policy violations.
  • Conduct audits and monitoring to identify compliance risks and address them accordingly.
  • Investigate and rectify policy violations, coordinating with relevant departments for necessary reporting.
  • Ensure compliance with HIPAA and confidentiality regulations, including the development of privacy policies and breach notification procedures.
  • Screen employees and contractors for compliance with federal healthcare regulations.
  • Coordinate auditing and monitoring activities related to contracts and managed care.
  • Establish a system for reporting and resolving conflicts of interest.
Privacy Management:
  • Ensure adherence to all privacy laws and regulations.
  • Address inquiries and requests related to personal information access.
  • Act as the primary contact for privacy-related matters, providing timely and accurate responses.
  • Conduct assessments of data processing activities to identify compliance risks.
Additional Information

This job description is intended to provide a general overview of the position and is not exhaustive of all duties and responsibilities. Responsibilities may evolve over time.

Qualifications
A Bachelor's degree in Nursing or a related field is required, with a clinical background preferred. A Master's degree is advantageous.

CPHRM certification or equivalent experience of 5+ years is preferred.

Professional credentials such as CPC, CHC, CPA, CIA, or similar are desirable.

Experience Requirements
A minimum of 3 years of experience in risk management is essential.

Experience in quality management and claims management within healthcare is preferred.

Experience in risk management, professional liability, or loss control is required.

Work Environment
Flexibility to work during holidays and weekends as needed. Proficiency in Microsoft Office Suite is essential. Strong interpersonal skills and the ability to foster effective relationships within the organization are critical.

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