Auto-apply to these jobs in Kentucky

Summary: As a change agent and member of Grace Health, this individual will play a pivotal role in developing, leading, and directing a high-performance healthcare risk and compliance program. This position will develop, lead, and advance the internal risk and compliance reporting processes for Grace Health. Furthermore, the individual will serve as an advisor, influencer, and enabler for enhanced program initiatives while ensuring that an integrated and well-coordinated, system-wide strategic risk and healthcare compliance program mitigates exposure for Grace Health’s clinical operations. The incumbent will leverage strong collaborative skills to maintain and monitor all grant activities; Federal Tort Claims Act (FTCA) matters, including deeming/redeeming, claims handling, sentinel events, and gap coverage coordination for services outside scope (e.g., SNF outreach); Patient-Centered Medical Home (PCMH) and Operational Site Visit (OSV) requirements, including evergreen compliance evidence (e.g., quarterly “OSV-ready” checks against HRSA Compliance Manual and PALs); Controlled Substance (HB1) compliance; Epic audit logs; access control reviews; 42 CFR Part 2 segmentation and disclosure tracking; and other key regulatory requirements that improve health outcomes and program impact. This role includes bringing together stakeholders across multiple departments and collaborating with external organizations that serve the communities within Grace Health’s service areas. The position carries day-to-day responsibility for managing the internal healthcare risk and compliance reporting process in alignment with Grace Health’s strategic goals and reports directly to the COO. ESSENTIAL DUTIES AND RESPONSIBILITIES: Develops and oversees Grace Health’s risk and compliance program. Develops and maintains relevant policies, procedures, audit tools, and training materials related to the risk and compliance program. Develops, implements, and maintains a compliance plan with Key Performance Indicators (KPIs) based on organizational requirements and identified risks. Ensures Grace Health’s policies and practices comply with federal and state laws and regulations, and follow industry guidelines to prevent illegal, unethical, or improper conduct. Develops, presents, and manages an annual risk and compliance calendar identifying all required organizational tasks, including timetables and accountability measures. Assists with the identification, implementation, and maintenance of entity-wide privacy policies. Oversees Grace Health’s clinical policy management workflows. Collaborates with Grace Health directors to ensure day-to-day operations of the program are established and executed according to the compliance plan. Partners with teams and staff to identify areas where risk and compliance input and guidance are required. In accordance with the risk and compliance program and plan, monitors clinical activities and conducts systematic audits for both risk and compliance with applicable rules and regulations, including HIPAA, Accreditation, CMS, and the HRSA Compliance Manual. Identifies potential areas of risk or compliance vulnerability, develops and implements corrective action plans to resolve complex issues, and provides general guidance on how to avoid or address similar situations in the future. Leads organizational efforts for FTCA and OSV applications, redeeming, and re-certifications. Communicates updates and changes related to regulatory and legal requirements, including the HRSA Compliance Manual, FTCA, PINs, and PALs. Oversees and leads team-based preparation, coordination, and follow-up for HRSA OSV reviews. Maintains a current understanding of federal, state, and local laws and regulations that impact Grace Health’s ability to provide patient care. Continuously identifies organizational and event-based risks and escalates such risks to Grace Health’s Executive Team. Provides departmental, organizational, and board dashboards as part of the risk and compliance reporting process. Oversees the incident reporting process and staff training for Grace Health. Ensures incident reports are accurate and addressed in a timely manner. Through regular reports and dashboards, keeps directors and officers informed on trends, concerns, and areas for improvement. Ensures Grace Health’s Safety and Emergency Preparedness Team is educated on applicable compliance standards for FQHCs, HRSA, State Medicaid, and Medicare. Manages compliance investigations and resulting corrective action plans. Responds to alleged violations of rules, regulations, policies, procedures, and the Grace Health Code of Ethics by evaluating, recommending, and following established investigative procedures. Leads the Compliance Committee as an unbiased review and evaluation body to ensure that compliance issues and concerns within the organization are appropriately evaluated, investigated, resolved, and reported. Consults with general counsel as needed to resolve complex or challenging legal compliance issues. Manages all organizational claims. Compiles and responds to all requests for claims-related information and works with local legal counsel to ensure timely and complete cooperation with the Department of Health and Human Services (DHHS) regarding claims. Performs other related duties as assigned by the COO. OTHER ESSENTIAL DUTIES and RESPONSIBILITIES: Grace Health recognizes that managing patient care is a team effort that involves clinical and non-clinical staff. All employees must adopt a team-based approach to patient care and realize that each role is essential to our success. Team members must demonstrate excellent team communication and coordination to provide quality patient care. Care coordination includes communicating with community organizations, health plans, facilities, and specialists. Care team members understand and embrace the concept of population management and proactively address the needs of patients and families served by this practice. Team members must demonstrate skill and knowledge related to effective communication with vulnerable patient populations. Team members must participate in Continuous Quality Improvement activities within the organization to ensure patients receive high-quality care. All team members will be involved in the process of improving quality outcomes. Team members will participate in the review and evaluation processes of practice performance and help to identify opportunities for improvement. Team members will participate in Grace Health's advocacy program . GENERAL DUTIES: Follow policies and procedures of the office, including administrative, clinical, quality assurance, and personnel Maintain good attendance (daily, meetings, and other assignment tasks) Maintain timely documentation of all work assignments Maintain patient confidentiality Routinely keep the supervisor informed about attendance and job assignments Flexible in being able to multitask Work effectively and at an efficient pace Work cooperatively with providers, administration, and peers QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and perform each essential duty satisfactorily. The requirements listed below represent the knowledge, skills, and/or abilities required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job. SKILLS: Intermediate-Advanced Computer skills – Microsoft Office (Word, Excel, PowerPoint, and Outlook). Clear and concise interpersonal and verbal communication skills and the ability to communicate effectively with a variety of personnel at all levels, both internally and externally. Sound judgment and strong commitment to ethical conduct and integrity. Strong problem-solving skills with the ability to identify relevant risks and propose solutions that consider relevant business objectives and compliance concerns. Ability to work independently in a fast-paced and dynamic environment. Strong attention to detail, excellent organizational skills, and the ability to work on multiple projects with tight timelines. EDUCATION and/or EXPERIENCE: Bachelor’s degree in Compliance, Paralegal Studies, Healthcare, or a related field is required. A master’s degree in a related field is strongly preferred. Minimum of five years of compliance work experience in a healthcare environment; risk management experience is a plus. 2+ years of accreditation and FQHC experience preferred. Demonstrated experience leading FQHC Operational Site Visit (OSV ) and Federal Tort Claims Act (FTCA) deeming cycles preferred. Strong working knowledge of HIPAA, HRSA, FERPA, CMS, False Claims Act, Anti-Kickback, OIG, and state regulations. Certification in Healthcare Compliance (CHC, CHPC, and/or CCEP) must be obtained within the first six months of employment. Epic electronic medical record proficiency (security/audit/reporting) preferred. Certified as a Patient Centered Medical Home Content Expert (PCMP-CCE) preferred. PHYSICAL DEMANDS: The physical demands described here are representative of those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand, walk, sit, and use hands to finger, handle, or feel objects, tools, or controls. The employee is occasionally required to reach with hands and arms; stoop, kneel, crouch, or crawl; and taste or smell. The employee must occasionally lift and /or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. WORK ENVIRONMENT: Grace Health is a faith-based, federally qualified community health center (FQHC). We provide primary health services to underserved, underinsured, and uninsured individuals in the southeastern Kentucky region. Our mission is “to show the love and share the truth of Jesus Christ to southeastern Kentucky, through access to compassionate, high-quality, primary health care for the whole person”. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Powered by JazzHR