Director of Risk Management/Compliance

BASIC FUNCTION
The Director of Risk Management is responsible for the management of HealthPoint’s Risk Management Program.
PRIMARY RESPONSIBILITIES AND DUTIES
1) Serve as the Risk Manager.
a) Develop and maintain a written risk management plan and annual evaluation of the plans’ effectiveness.
b) Develop and maintain policies and procedures related to the risk management program to identify, assess, and mitigate risks across the organization.
c) Conduct rounding on all clinics at least quarterly
d) Responsible for confirming compliance with the Federal Torts Claims Act in order for HealthPoint to maintain coverage.
e) Collaborates with HealthPoint’s quality improvement team and other departments to identify opportunities for improvement in risk management processes and procedures.
2) Maintain Compliance and Regulatory Oversight
a) Ensure compliance with relevant laws, regulations, accreditation standards related to risk management, including but not limited to Human Resources and Services Administration.
b) Stay updated on industry trends and changes in regulation to ensure HealthPoint’s risk management practices align with current requirements.
c) Conduct regular audits and assessments to identify areas of non-compliance and develop action plans for corrective measures.
3) Maintain Incident Reporting and Investigation Systems
a) Develop and oversee the processes for internal incident reporting regarding clinical events in conjunction with the medical team and lead/participate in development of root cause analysis as directed by Chief Compliance Officer.
b) Assemble, analyze, and report aggregated, trended data on incident reports and claims to the Risk Management Committee and the Board of Directors.
c) Oversees HealthPoint’s incident reporting and investigation process, including developing and implementing protocols for reporting and reporting to incident
4) Conduct Education and Training
a) Develop and deliver risk management education and training programs to employees at all levels
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b) Promote awareness of risk management principles and practices throughout HealthPoint
c) Provide guidance and support to departmental managers in implementing risk management training within their respective areas
d) Monitor and evaluate the effectiveness of training initiatives and make recommendations for enhancements.
5) Serve as the Service Recovery Specialist
a) Service Recovery Calls: Receive and manage incoming service recovery calls from patients who have experienced issues or dissatisfaction with HealthPoint’s services. Demonstrate excellent communication skills to listen actively, empathize with patients, and gather relevant information about their concerns.
b) Complaint Resolution: respond to patients’ complaints and concerns promptly, professionally, and with utmost empathy. Analyze the issues raised by patients and collaborate with relevant departments to develop appropriate solutions and action plans for resolution.
c) Documentation and Reporting: maintain accurate and detailed records of patient complaints, resolutions, and any follow-up actions taken. Prepare regular reports on service recovery trends, outcomes, and recommendations for improvement.
d) Continuous Improvement: stay informed about industry trends, best practices in service recovery, and patient satisfaction strategies. Share knowledge and recommendations with the team to continuously improve our service recovery processes.
6) Serve as the Privacy Officer
a) Develop and implement privacy policies and procedures. Collaborate with CCO, senior leadership team, legal counsel, and other stakeholders to establish comprehensive privacy policies and procedures that align with applicable laws, regulations, and industry standards
b) Conduct regular privacy assessments and audits to identify potential risks and vulnerabilities. Develop mitigation strategies and ensure corrective actions are taken promptly.
c) Send at least quarterly HIPAA reminders
7) Performs other duties as assigned –
a) Effectively carries out tasks and responsibilities beyond core job duties and primary role. The additional duties may vary from time to time and encompass a wide range of activities that contribute to the overall success of the organization (floating, schedule variations, assisting co-workers, patients, visitors, customers, leaders, and other stakeholders in support of the organization.)
Leadership Responsibilities
1. Provides overall management and direction of the Risk Management Program.
a. Oversees the development and maintenance of the budget; monitors ongoing budgetary compliance and addresses problems as needed.
b. Delegates departmental duties and responsibilities to management; participates in high priority special projects and activities.
c. Represents the Department/Division at senior management meetings.
d. Prepares Department/Division company policies and procedures and conveys all senior management communications and directives.
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e. Monitors Department/Division performance using company performance standards and addresses issues as needed.
f. Directs Department/Division performance and provides specific instructions to managers and supervisors on completion of tasks/responsibilities.
g. Maintains open communication with leadership to provide updates on team/individual performance and address any concerns.
h. Prepares and conducts performance appraisals for immediate staff
i. Conducts hiring, disciplinary, and termination procedures
j. Provides excellent customer service and resolves concerns/complaints/issues in a timely professional manner.
k. Effectively prioritizes tasks and projects based on business needs and resources.
l. Ensures alignment of initiatives with organizational priorities and objectives.
m. Manages competing demands and adapts to changing priorities.
MISSION, VISION, AND VALUES
1) Empathy - Demonstrates a high level of empathy, respect, and understanding of diversity in the workplace by treating all patients, guests and colleagues with dignity, courtesy, and inclusivity, and by actively seeking to learn from different perspectives and experiences.
2) Excellence - Consistently upholds high ethical and safety standards and demonstrates unwavering integrity in all work-related activities. Strives for excellence in job performance.
3) Enjoyment - Displays enjoyment (gratitude), a commitment to learning, and professionalism by actively seeking feedback, accepting constructive criticism, and demonstrating a willingness to grow and improve in their job role.
4) Commitment to Patient/Customer Service - Exhibits exceptional patient/customer service skills, consistently providing professional support. Demonstrates effective communication skills, actively listening to patients/customers, and responding promptly to inquiries and concerns. Handles challenging situations with tact and diplomacy, ensuring timely resolution of problems and fostering positive patient/customer experiences
CULTURE
1) Gratitude - Displays a positive and appreciative mindset and supports happiness and well-being in self and others.
2) Collaborative Team - Demonstrates flexibility, enthusiasm, and willingness to cooperate while working with others in an inter-professional team to support organizational activities. Identifies and supports opportunities for the professional development of team members.
3) Quality Improvement - Collaborates with team to drive continuous improvement initiatives to enhance quality standards, processes, and outcomes.
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4) Accountability - Ensures consistent adherence to regulatory guidelines and HealthPoint policies and procedures. Takes accountability for mistakes and errors.