Regulatory and Compliance Specialist (71694) at Overland Park

Job Description

• Region VP Clinical Operations strategically leads the clinical service analysis, development, implementation, and measurement for a growing hospice region.
• Primary accountability is to ensure the delivery of consistent, high-quality patient care, direct disease symptom management, specialty program, and transitions between Home Health and Hospice via the Clinical Bridge programs within the region.
• Serves as a key member of the Region executive management team.
• Works under general direction.
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Manages the Clinical Operations Support Team in providing support to operations in achievement of identified clinical and operational goals. Directs team members in improving clinical outcomes, operational processes, responding to exceptions in performance metrics (e.g., clinical outcomes, audit results, compliance directives and investigations, state survey results) and ensures participation in performance improvement activities. Performs all duties inherent in a supervisory role.
• Ensures effective and ongoing, on-the-job training of team members, evaluates and records individual and team performance, provides coaching and counseling, and makes appropriate developmental and salary adjustment recommendations.
• Ensures and facilitates consistency in practice and message among Clinical Operations Support Team members.
• Develops and prepares reports to inform Regional and Divisional leadership teams of team initiatives, project status, issues, results, achievements, etc.
• Keeps abreast of company requirements and communicates changes to team members.
• Acts as an advocate for the Operations Support Team by identifying fundamental opportunities to improve the overall operations support process.
• Participates in the interviewing of potential new program staff as well as administrative staff and makes hiring recommendations.
• Participates in assuring that adequate resources are available to ensure the clinical stability of all locations in region and prioritizes the deployment of support resources in collaboration with operations management.
• Consults with the management team regarding deployment of Clinical Support Team to ensure that the most critical needs are addressed first. Collaborates with up-line managers, operations management, peers, and Division Clinical Department to ensure coordination of efforts and efficient support is provided to all offices.
• Evaluates and ensures operations’ efforts in complying with local, state and federal regulations, accreditation standards, clinical practice standards, corporate compliance standards, as well as company policy, as applicable.
• Reviews with team and directs improvement to the reimbursement process (e.g. utilization management, billing release, focused medical reviews (FMRs), and denials).
• Augments direct support efforts, providing on-site support, as indicated; directly involved in supporting the implementation of Plans of Correction for any condition-level deficiency survey and/or any immediate jeopardy survey to ensure return to stability and positive survey outcomes.
• Guides Operations Support Team in supporting the implementation of new process procedures and methods.
• Works with management to direct and facilitate the implementation of clinical processes and programs within the region with a focus on the integrity of clinical oversight, management and practice.
• Collaborates with operations management, sales, human resources, and/or finance team members in developing and implementing strategies to achieve identified goals.
• Monitors identified performance indicators develops strategies to facilitate improved performance; consults and collaborates with Support Team and operations partners to implement improvement strategies.
• Consults with regional/division staff and clinical delivery/business contacts to identify solutions to client need/problems.
• Participates and guides Operations Support Team in supporting the implementation of region-specific initiatives and/or programs.
• Ensures and coordinates communications and information flows between Governing Body, corporate/division support groups, regional leadership and field operations within assigned region.
• Acts as an advocate for clinical and program operations by participating with corporate/division departments and line management in providing feedback and recommendations for the development and implementation of policies, processes and systems to ensure compliance, positive survey outcomes and successful implementation of corporate and division initiatives.
• Provides expertise to all levels of field organization regarding the interpretation of policies and processes, procedures, standards and regulations.
• Supports/implements Company sponsored programs (e.g. clinical, marketing, risk management) and recommends new programs to corporate/division staff as appropriate.
• Recommends clinical process improvement methods.
• Keeps abreast of industry trends and regulatory requirements thru activities such as participating in state associations, attending courses/seminars/workshops and reviewing industry publications.
• Participates in planning and creating the region’s strategic, operational, service design and other organizational plans and policies to achieve the mission and vision of the Hospice Division.
• Serves as a strategic partner with the Regional team in the planning and development of regional and area budgets, revenue, capital and operational expenses, sufficient number of staff, and any other plans for allocation of fiscal or other resources according to the scope of services provided.
• Directs the coordination and integration of clinical initiatives with other departments to reduce multiple initiative rollout simultaneously.
• Communicates the Hospice Division’s mission, vision, and plans with staff and guides them in their day-to-day activities. Promotes and motivates staff members to implement area and regional operational, programmatic and other plans.
• Recommends and determines the sufficient number of staff to provide services and defines qualifications, performance expectations and competence of each person.
• Ensures orientation, in-service training, continuing education, annual performance and competency reviews of personnel are completed to ensure staff is competent to provide services.
• Periodically participates in program and area performance improvement activities to measure and assess the quality of services provided.
• Ability to direct the preparation of short-term and long-range plans and budgets based on broad corporate goals and growth objectives.
• Maintains a sound plan of corporate organization, making recommendations for policy changes to insure adequate management development and to provide for capable management succession.
• Develops and installs procedures and controls to promote communication and adequate information flow both internally in the region and externally to the areas and programs.
• Establishes clinical operating policies and procedures consistent with the Regional Vice President of Operations and Regional Vice President of Sales broad objectives and ensures their execution.
• Evaluates the results of overall clinical operations regularly and systematically and reports these results to the Regional Vice President of Operations and the Division VP of Clinical Operations.
• Ensures that the responsibilities, authorities, and accountability of all direct subordinates are defined and understood.
• Responsible for the overall direction, coordination and evaluation of the subordinate areas/programs.
• Maintains an environment of collaboration and cooperation among operations, clinical, and sales departments.
• Ability to effectively present written and verbal information to top management, medical staff, public groups and referral services.
• Ability to read, analyze and interpret financial reports and contracts.
• May assume the administrative responsibilities of the RVPO in his/her absence.

People

• Promotes staff development by establishing a professional environment that supports accountability and autonomy.
• Shares knowledge and skills with nursing staff, students, colleagues, and others and acts as a role model and mentor.
• Works with HR Director and Recruiting Manager to lead clinical recruitment and retention efforts by planning and implementing new and creative initiatives to both attract and retain nurses and other key employees.
• Provides leadership in partnering with human resources related to development and management.
• Provides appropriate guidance and counsel to clinical resources within the region.
• Provides appropriate and timely communication within all departments and disciplines.
• Maintains confidentiality of employee information to assure employee rights are protected.
• Adheres to and promotes Equal Employment Opportunities, with respect to the division’s Affirmative Action Plan.
• Demonstrates ability to fairly and consistently apply the disciplinary process.

Quality

• Understanding of billing and ADR (Additional Documentation Request) process and oversees adherence to company policies and timelines to ensure compliance with the Conditions of Participation, all regulatory body surveys, such as, TJC, State Licensing Review and CMS Validation surveys.
• Contributes to and/or leads the appropriate initiatives outlined in the QAPI Plan and understands and supports the organization’s continuous quality initiatives. Represents clinical services on various corporate, program and medical staff committees/meetings.
• Assures compliance with all regulatory and accreditation requirements. Maintains survey readiness at all times. Participates in and coordinates survey preparation. Develops, implements, and monitors corrective action plans as needed.
• Develops and implements policies and procedures and provides resources for maintaining patient safety and compliance with state/governmental regulations pertaining to clinical services and to the hospice division.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Growth

• Assists the sales team in developing a positive image and relationship in the community and serves as a visible advocate for the company in working with area nursing programs, other healthcare institutions and community organizations.
• Collaborates with medical director and other departments in planning and organizing the implementation of clinical services and programs as appropriate.
• Continually strives to achieve ongoing professional growth and maintains personal competency.
• Assists the company in establishing credibility with patients, physicians, staff, referral sources and colleagues through the continuation of excellent patient care and the enhancement of clinical competencies across the organization as appropriate.

Financial

• Collaborates with regional leadership in the preparation of a budget and the development of a capital expenditure plan.
• Accountable for cost controls related to patient care to insure maximum effectiveness of funds expended.
• Works with RVP-O to assure fiscal resource allocation to support current and potential clinical objectives and initiatives to optimize the provision of quality, cost effective care.
• Responds appropriately to budget variances, including determining justifications and/or developing corrective measures.
• Takes an active role in the Additional Documentation Request (ADR) process to ensure compliance and collaboration with requested information and to identify trends and variances to the company standard for patient care and documentation.
• Serves as an active member of the regional senior leadership team, interacting with the medical executive staff, corporate resources, and other groups as appropriate.
• Develops, implements, and improves the care delivery model by assessing quality and efficiency and leading appropriate change that meets or exceeds customer expectations.
• Acts as an advocate for patients and families.
• Networks with state, regional and national peers and colleagues to share ideas and conduct mutual problem solving.
• Seeks experiences to advance one’s skills and knowledge base through such activities as education, certification, and participation in professional organizations.

Compliance

• Maintains confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected.
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
• Attends all mandatory in-services and staff meetings.
• Represents the organization in a positive and professional manner.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics, and goals of the company, as well as the focus statement of the department.
• Maintains current licensure/certification for position.
• Consistently demonstrates Guest Relations skills to patients, physicians, visitors, employees, and any other individuals with whom they may come in contact.

Job Requirements

• Bachelor’s degree in Nursing.
• Master’s degree in Nursing or related field preferred.
• Minimum of eight years health care administration or hospice administration experience, including three years in hospice operations management.
• Experience with multi-site operations responsibility preferred.
• The Region VP Clinical Operations is a highly motivated and committed professional with demonstrated expert knowledge of clinical and financial operations.
• Must possess a demonstrated track record of managing and developing successful clinical service strategies, improving quality outcomes, and implementing successful continuous performance improvement initiatives in a multi-site environment.
• Must be a strategic business thinker in addition to a strong clinician and possess effective strategic leadership skills who can direct as well as influence patient care delivery and decision-making at the regional level.
• Additional knowledge, skills, and abilities to be successful in this role include.
• Broad knowledge of hospice federal and state regulations/administration required.
• Excellent organizational, problem-solving, decision-making, assertiveness, presentation, and communication skills required.
• Travel required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Country: USA, State: Kansas, City: Overland Park, Company: Gentiva Health Services, Inc..