Risk And Corporate Compliance Manager (2157)

JOB SUMMARY: Responsible for the coordination, implementation, and oversight of LifeStream's Risk Management and Corporate Compliance Programs. Supports organizational efforts to identify, assess, monitor, and mitigate organizational and regulatory risk while promoting compliance with federal, state, accreditation, contractual, privacy, and payer requirements. Provides leadership and oversight for corporate compliance activities, investigations, grievances, privacy and confidentiality matters, claims management, organizational liability reduction, regulatory reporting, and healthcare risk management initiatives.

Collaborates with operational, clinical, and administrative leadership to foster a culture of integrity, accountability, compliance, ethical conduct, and continuous improvement while protecting the organization's consumers, employees, reputation, assets, and regulatory standing.

Works in partnership with the Director of Safety, Emergency Management & Environment of Care, who maintains responsibility for operational safety functions including safety management, security, workplace violence prevention, emergency management, life safety, environment of care, OSHA compliance, utility management, fire and disaster preparedness, environmental rounding, and safety training programs.

The primary focus of this position is corporate compliance oversight, healthcare risk management, investigations, grievances, privacy and HIPAA compliance, regulatory reporting, claims and liability management, accreditation support, audit activities, and organizational risk reduction.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES: The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification with or without an accommodation. It is not necessarily descriptive of any one position in the class. The omission of an essential function does not preclude management from assigning duties not listed herein if such functions are a logical assignment to the position.

Risk Management Program Administration

• Coordinate, implement, and oversee the organization's Risk Management Program.
• Identify, assess, monitor, and mitigate organizational risks affecting consumers, employees, operations, finances, reputation, and organizational liability.
• Maintain oversight of incident reporting systems and risk management processes.
• Conduct organizational risk assessments and monitor emerging enterprise risks.
• Evaluate organizational practices and services to identify liability exposure.

Corporate Compliance Program Administration

• Coordinate and oversee the Corporate Compliance Program.
• Monitor compliance with applicable laws, regulations, payer requirements, contractual obligations, and organizational policies.
• Conduct compliance reviews, investigations, monitoring activities, and audits.
• Administer compliance reporting mechanisms and ensure appropriate investigation and resolution of reported concerns.
• Evaluate the effectiveness of compliance activities and recommend improvements.

Incident, Investigation, and Grievance Oversight

• Direct and oversee investigations involving incidents, adverse events, grievances, complaints, privacy concerns, compliance issues, abuse allegations, and potential organizational liability.
• Coordinate root cause analyses and corrective action plans related to compliance, risk, grievances, and organizational liability concerns.
• Monitor implementation and effectiveness of corrective actions and mitigation strategies.
• Chair the Complaints and Grievance Committee and oversee organizational grievance management activities.

Compliance Hotline and Reporting Program Oversight

• Oversee the Corporate Compliance Hotline and related reporting mechanisms to ensure concerns are received, documented, routed, and addressed appropriately.
• Ensure allegations of misconduct, fraud, waste, abuse, privacy concerns, and compliance violations are investigated and resolved appropriately.
• Maintain non-retaliation protections for reporting parties.

OIG/SAM Exclusion Monitoring

• Oversee monthly OIG, SAM, Medicaid exclusion, and other sanction screening activities for employees, contractors, providers, interns, board members, and vendors.
• Monitor exclusion status and coordinate corrective actions when necessary.

Fraud, Waste, and Abuse Oversight

• Coordinate investigations related to suspected fraud, waste, abuse, billing irregularities, documentation concerns, or misuse of organizational resources.
• Partner with Finance, Clinical Operations, and Legal Counsel to address identified concerns.

Contract and Regulatory Compliance Monitoring

• Monitor compliance with federal, state, grant, payer, and contractual requirements.
• Coordinate compliance reviews associated with grant-funded and contracted services.

Compliance Work Plan Administration

• Develop and administer the annual Corporate Compliance Work Plan.
• Monitor progress on compliance initiatives and report outcomes to executive leadership and the Compliance Committee.

Corporate Integrity and Ethics Program

• Promote organizational ethics, standards of conduct, and corporate integrity initiatives.
• Support implementation of the LifeStream Code of Conduct and associated training programs.

Regulatory Reporting and Accreditation Readiness

• Ensure timely and accurate reporting of incidents, adverse events, breaches, investigations, and other required notifications to regulatory, licensing, accreditation, and oversight agencies.
• Coordinate compliance readiness activities related to CARF, AHCA, DCF, CMS, HIPAA, and other regulatory requirements.
• Serve as a liaison and resource during surveys, audits, reviews, investigations, and accreditation activities.

Privacy, Confidentiality, and Information Security Oversight

• Coordinate investigations involving privacy, confidentiality, protected health information, and information security concerns.
• Partner with Information Technology, Operations, Human Resources, and Legal Counsel to reduce privacy and security risks.
• Monitor compliance with privacy, confidentiality, and information security requirements and recommend corrective actions when necessary.

Sentinel Event and Risk Reduction Management

• Coordinate the investigation, review, and follow-up of sentinel events, serious reportable incidents, abuse allegations, neglect allegations, and other significant events.
• Promote risk reduction activities through proactive and reactive interventions.

Organizational Liability and Claims Management

• Coordinate organizational response activities related to claims, litigation support, insurance matters, and legal inquiries.
• Maintain documentation related to claims, investigations, liability exposure, and organizational risk.
• Collaborate with legal counsel and insurance carriers regarding liability issues and claims management.

Leadership Reporting and Consultation

• Develop and maintain organizational risk, compliance, grievance, privacy, and performance dashboards.
• Analyze organizational data to identify emerging compliance, quality, privacy, grievance, and liability trends.
• Recommend proactive interventions based on identified risk patterns.
• Prepare and present reports to executive leadership, governing boards, committees, and other stakeholders regarding risk, compliance, grievances, investigations, claims, and organizational liability.
• Provide consultation and technical assistance to leadership regarding risk management, compliance, privacy, investigations, and liability concerns.

RESPONSIBILITIES:

• Participate in Quality Improvement Council activities and other organizational committees.
• Develop, review, revise, and maintain risk management, compliance, grievance, privacy, claims management, and related policies, procedures, plans, and forms.
• Collaborate with Human Resources, Clinical Leadership, Operations, Finance, Information Technology, Quality Improvement, and Legal Counsel regarding organizational risk and compliance matters.
• Develop and provide staff education and training related to compliance, privacy, incident reporting, investigations, grievance management, and risk reduction.
• Assist programs and departments in developing corrective action plans related to compliance findings, investigations, grievances, and risk mitigation efforts.
• Collect, analyze, maintain, and trend data related to incidents, grievances, complaints, compliance findings, investigations, claims, and operational risk indicators.
• Monitor industry trends, regulatory changes, accreditation standards, and best practices and communicate relevant updates to leadership.
• Serve as Single Point of Contact (SPOC) for Deaf and Hard of Hearing accommodations and complete related reporting requirements.
• Complete required voter registration reporting and other assigned regulatory reports.
• Maintain records and documentation necessary to support surveys, audits, investigations, accreditation reviews, claims, and legal proceedings.
• Promote a culture of integrity, accountability, compliance, and continuous improvement throughout the organization.
• Perform other duties as assigned.