Summary of Position:

This position is responsible for identifying, implementing, monitoring, and evaluating the overall risk management and corporate compliance plans at Community Health Centers of Greater Dayton (CHCGD). This position works collaboratively with all disciplines to establish a safety culture, emphasizing clinical risk, patient safety, visitor, third party, volunteer, and employee safety, as well as potential business, operational, and property risks. Manages and monitors the CHCGD’s compliance and Risk Management effort, reporting identified issues directly to the Chief Executive Officer.

Risk Management

• Create Risk Management training plan for staff based on quarterly safety checks, incident report trends, observations by management team, annual OSHA and Compliance requirements, and other identified needs.
• Maintain and update the CHCGD Risk Management Plan and ensure alignment with strategic goals.
• Oversee or conduct risk assessments, walk through inspections, adverse event reports, past accreditation or licensing surveys, medical records, risk analysis methods to identify, evaluate, prevent and control the risk of injury or loss.
• Identify, assess and mitigate clinical, operational, financial and reputational risks across the organization.
• Report on Risk Management activities to the Risk Management Committee.
• Prepare the quarterly and annual QA/Risk Management reports for the Board.
• Coordinate submission of annual FTCA malpractice application
• Oversee incident reporting and patient complaints and participate in root-cause analysis of occurrences or possible occurrences.
• Participate in HRSA reporting and site visits.
• Coordinate Disaster Management and Preparedness activities
• Oversee the Respiratory Protection Plan and implementation.

Compliance

• Develop, implement and maintain a comprehensive compliance program in accordance with HRSA, OIG, OSHA, FTCA and other regulatory requirements.
• Serve at CHCGD’s designated compliance officer.
• Assists Quality Coordination, Operations staff and the Executive Management Team in the review, revision and formulation of appropriate policies and procedures to guide issues of compliance.
• Assures compliance of federal, state, and local laws, as well as the HRSA Compliance Program.
• Conduct regular compliance risk assessments and audits: develop corrective action plans as needed.
• Participate in HRSA reporting and site visits.
• Ensure ongoing compliance with CHCGD’s Corporate Compliance Plan
• Monitor and interpret changes in healthcare laws, regulations, and guidelines and update policies and procedures accordingly.

Management

• Manage the Clinical Training Program
• Lead the implementation of the infection control plan as well as respond to implementation questions from managers.
• Assist with and/or conduct EHR/PM system training for staff and providers.
• Coordinate the Clinical and EHR Training of staff (Manages Staff Development Specialist activities)

Qualifications, Skills, and Abilities

• Working knowledge of Risk Management and Compliance processes.
• In-depth knowledge of HRSA, FTCA, HIPAA, CMS and other relevant regulations.
• Demonstrate initiative, ability to work with others and good professional judgment.
• Able to work independently and organize time effectively.
• Excellent written and verbal communication skills.
• Strong organizational skills and attention to detail.
• Able to work with confidential information.
• Proficiency in MS Office products, such as Word, Excel, Power Point and Outlook.
• Working knowledge of EHR
• Coaching, mentoring, and teaching skills.
• Ability to relate well to people from diverse ethnic and cultural backgrounds.
• Motivate and inspire others by setting a positive example, solicit and/or provide innovative ideas from staff, co-workers, and physicians.
• Open to feedback for improvement, willingness to change, and be flexible.

Required Knowledge, Licensure/Registration

• Graduate of LPN or Registered Nursing program with current licensure or related healthcare degree preferred; BSN preferred.
• Current CPR certification is required.
• Ambulatory, CHC or primary care experience preferred. Familiar with standard concepts, practices, and procedures within healthcare office setting.
• Previous experience with risk management and compliance required.