SVP, Quality Improvement & Corporate Governance Health Integrated
THIS JOB HAS EXPIRED Description
Position is based in Tampa, FL
JOB SUMMARY: The SVP, Quality Improvement and Corporate Governance is responsible for the development and maintenance of the general operation of the Quality Improvement program, the Compliance Program and its related activities to ensure compliance with certification and regulatory requirements and to prevent illegal, unethical, or improper conduct. This role will manage the day-to-day operation of the Program. This includes the oversight of Corporate Compliance, HIPAA as well as Quality.
Education/License/Certification: Bachelor?s Degree in health related field required. Master?s Degree is preferred, current, unrestricted RN or equivalent licensure is required. Additional certification in specialty fields or other advanced certification preferred.
Experience: 8-10 years experience in Quality Improvement. Five years Director Level or higher management experience specifically in Quality Improvement/management. Working knowledge of NCQA and URAC accreditation standards and
direct experience with and responsibility for NCQA and URAC surveys. A minimum of one year of compliance experience within a healthcare company. Experience in both the health plan environment as well as in a health plan
vendor organization environment is preferred.
High level of personal and professional integrity and trustworthiness with strong work ethic and the ability to work independently with minimal direction.
Current, broad-based expertise in managed care, quality improvement processes, URAC, NCQA, and state and federal guidelines in healthcare.
Ability to lead, influence create and work within cross-functional team environments. To be the internal expert in these domains and to be capable of working with counterparts and CMOs of clients as necessary in on going compliance efforts and sales opportunities.
Sound critical thinking, communications skills.
Keeps abreast of current regulatory and clinical practices and utilizes this knowledge during the ongoing development and adjustment of the company plans.
Assertive, take-charge proven manager with strong results orientation, positive ?can do? attitude and a sense of urgency to get things done.
Ability to do presentations inside and outside the organization.
Statistical and analytical skills.
Sound computer skills and experience with Microsoft Office Suites including the development of spreadsheets.
Develop, initiate, maintain, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
Manages day-to-day operation of the Program.
Develops and periodically reviews and updates Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.
Organizes, directs and controls the certification efforts of the organization including NCQA and URAC; both in the development and maintenance of appropriate procedures and the oversight of periodic certification reviews by external bodies.
Collaborates with other departments (e.g., Risk Management, Internal Audit, Employee Services, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution.
Responds to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures.
Acts as an independent review and evaluation body to ensure that compliance Issues/concerns within the organization are being appropriately evaluated, investigated and resolved.
Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
Provides reports on a regular basis, and as directed or requested, to keep Senior Leadership informed of the operation and progress of compliance efforts.
Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
Establishes and provides direction and management of the compliance Hotline.
Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
Monitors the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness.
Monitors the structure, functions, and coordinate the HI Quality Improvement Committee
Oversight of the QI staff and department
Monitors compliance with all accreditation
Implementation of organizational wide quality improvement indicators and processes
Develops and implements the Quality Improvement program description, evaluation and work plan
Provides support, educates and mentors staff
Monitors all accreditation standards and ensures they are met and implemented throughout the organization
Assist Operations in the clinical process and the clinical integrity of clinical programs
Identify changes in healthcare accreditation environment and communicate those changes to appropriate individuals/departments
Others duties as requested and/or assigned by the Chief Financial Officer and/or Chief Medical Officer
Customer Services ? Internal:
Supports a positive working environment
Identifies and resolves potential personnel/peer problems and issues proactively
Monitors and reports to QI committee as well as the Executive Management Team any issues or concerns related to QI indicators
Maintains a courteous and professional attitude when working with all staff members and the management team and other departments
Customer Services ? External:
Maintain a professional attitude/image when communicating with HI visitors, customers, and/or clients
Collaborates with HI clients/customers/audit/surveyors in a professional manner
Report all quality improvement data/issues to HI?s clients in a timely manner
Supports/maintains positive relations with HI clients/customers
Health Integrated is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, sexual orientation, political affiliation, color, religion, national origin, age, disability, veteran status, genetic data, or religion or other legally protected status. EOE M/F/D/V
||10008 North Dale Mabry |
Tampa, FL 33618
THIS JOB HAS EXPIRED