PA Primary Care Career Center – Find your Passion and PurposePA Primary Care Career Center – Find your Passion and Purpose

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Sto-Rox Family Health Council, McKees Rocks – Quality Management & Compliance Director

Job Summary
The QMC Director provides oversight to ensure compliance with all applicable law and policy and to encourage performance improvement. Consistent with community health center requirements, s/he is responsible for creating and implementing an annual plan for QMC review, managing the center Risk Management program, for conducting reviews, creating reports and making recommendations regarding policy, procedure and training based on those reviews, and for taking complaints regarding compliance, investigating and making recommendations for actions based on the results of the investigation. The QMC Director works closely with all department leaders and key program managers and reports regularly to the Associate Executive Director, chairs the QMC Committee, and reports to the Board of Directors directly.

Duties and Responsibilities

• Develops guidelines and systems for the center QMC and Risk Management Programs to be approved by the Executive Director and Board and periodically recommends updating of the same.
• Develops a detailed plan for implementation of the center QMC Program including routine and random internal reviews, special investigations, and reports as needed.
• This plan will include reviews of every activity of the center.
• Some of the reviews in the plan will be assigned by the QMC Director, some will be conducted by the QMC Director.
• Coordinates review activities with department heads to ensure that all internal audits are sufficiently rigorous to prevent and detect misconduct or inappropriate processes.
• Responsible for risk management monitoring, goal establishment, quarterly tracking, and annual reporting to the Board of Directors
• Manages and processes all medical malpractice claims for the health center in accordance with center policies and the HRSA FTCA handbook
• Chairs the QMC Committee meetings and attends Department Staff meetings, and makes Clinical Reports at Senior Staff meetings.
• Monitors clinical quality metrics (e.g. HEDIS, UDS, etc.) and develops process improvement initiatives in conjunction with the Medical Director.
• Ensures that patient and staff complaints are reviewed in a timely and effective fashion so that problems are investigated and addressed appropriately.
• Conducts or oversees investigations of any allegations of misconduct or variance from the center Code of Conduct or center policies and procedures.
• Ensures that the rights of persons reporting in good faith as well as alleged violators are protected consistent with the law.
• Secures legal counsel through the Executive Director concerning complaints and/or investigations to ensure that appropriate measures are taken to protect the liability of the center and its Board and staff, and to comply with all reporting and other requirements.
• Reports to the QMC Committee concerning summaries of audits and reviews to implement changes in measures and monitors to prevent misconduct and errors, and to implement performance improvement measures, as appropriate.
• Evaluates the center QMC Program and reports to the Board concerning the implementation, operations and activities of the program and make recommendations to promote efficiency, performance improvement, quality of services, and to reduce vulnerability to fraud, waste and abuse.
• Reinforces center corporate culture that encourages Board, leadership, staff and independent contractors to solicit and report suspected fraud or misconduct without fear of retaliation.
• Performs other related duties as assigned by the Executive Director.

Knowledge, Skills and Abilities
Required

• Leadership and managerial skills
• Computer skills with Microsoft Windows and Office Professional (Word, Excel, and PowerPoint), including knowledge of computer technology in a health care setting
• Audit and investigatory skills
• Strong interpersonal skills
• Excellent writing and presentation skills
• Able to organize work, develop procedures and follow instructions
• Able to maintain confidential documents and information

Preferred

• Broad-based knowledge of the scope of operations of a community health center
• Knowledge of compliance and performance improvement
• Demonstrated ability to develop studies and conduct reviews using measures or indicators

Credentials and Experience

Required

• Bachelor’s Degree in Nursing
• A minimum of three (3) years healthcare experience and two (2) years in a supervisory capacity in a position with similar responsibility
• Experience administering grants
• Experience in accounting systems and MS Office proficiency
• Experience maintaining confidentiality

Preferred

• Master’s Degree in Nursing
• Nonprofit experience
• Health center experience
Special Requirements
• Pass a stringent screening to determine any history or record of any misconduct or criminal activity;

Have credible references to qualify
Job Type: Full-time



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