QUALIFICATIONS

Graduate of an accredited college or school. Bachelor's Degree and/or nurse preferred. Must possess current experience and training in the area of Medicare, Medicaid, and commercial healthcare oversight and regulations. A minimum of five (5) years in healthcare related field, and minimum of two (2) years of hospice and/or palliative, or end of life care required. Prior management experience preferred.

Must demonstrate knowledge of healthcare compliance, accrediting standards, QAPI requirements, federal and state hospice regulations, and COP’s, ACHC, PHI / HIPAA, and high-tech healthcare requirements.

Experience with electronic medical records system(s). Able to be a lead super user with proficiency in understanding software. Able to identify improvement needs, work with IT with updates, and train staff on use, documentation, and compliance. Role requires travel quarterly and as needed.

REPORT TO

Corporate Compliance Director or Designee

KNOWLEDGE AND COMPETENCY

Thorough knowledge of current federal and state regulations in the hospice field with comprehensive knowledge in quality improvement requirements and multi-disciplinary patient care. Must have the ability to multi-task to complete all assignments on a timely basis. Must have excellent documentation skills and have the ability to review documentation for compliance. Works well with others. Functions well under pressure independently.

Must have the ability to communicate effectively at all levels. Required to evaluate and update the company’s compliance program annually. Maintains confidentiality of information as required by laws and regulations.

Requires computer software and hardware competence at a level to perform EMR lead super user responsibilities.

JOB RESPONSIBILITIES

(includes but not limited to the following):

1. Leads the clinical panel, ensuring qualified personnel are assigned and responsive to the submissions. Ensures appropriate responses and outcomes are available.
2. Performs the compliance and quality improvement activities for Hospice, working closely with other clinical leaders in each branch.
3. Ensures that desired compliance outcomes are achieved and sustained by ongoing concurrent branch and company review, training, and oversight.
4. Immediately notifies supervisor and upper management of any potential legal issues.
5. Works collaboratively with supervisor and management staff in oversight of branch QAPI processes. Attends monthly QAPI meetings for all branches. Notifies supervisor and upper management of unfavorable results/delinquent plans on a monthly basis.
6. Ensures compliance and standards of care for federal, state, and local regulations are met. Ensures all accreditation standards are met. Provides training to branch staff as required.
7. Works collaboratively with the education department. Notifies the education department and/or upper management regarding identified compliance and performance needs. Oversees branch follow-through is achieved. Assists the education department in developing education as needed, and approves education provided to the branches.
8. Oversees completion of the annual comprehensive branch assessment, which identifies compliance and quality improvement opportunities. Performs quarterly mock audits utilizing the BAT to determine improvement opportunities/trends, and reports this information back to supervisor and upper management in a written summary.
9. Assists management in developing programs/processes. Evaluates current branch processes to standardize all programs/processes across the organization. Assists in implementing new processes/programs and refining existing processes/programs.
10. Gathers documentation for all record requests/ADR’s, and submits to supervisor for review.
11. Acts as a resource to branch management, and filters information to the direct supervisor as needed.
12. Completes HIS/CAHPS/FEBS documentation and submission
13. Works with branches and management to complete surveys and survey preparedness
14. Assists compliance with policy and procedure review and creation regularly and on an as needed basis.
15. Other duties as assigned.

PHYSICAL DEMANDS

Must be able to complete all physical demands of the job including but not limited to: the ability carry supplies, equipment, travel, and read normal typewritten print. Have corrected vision and hearing within normal range and have manual dexterity with normal range of motion of all extremities. May be requested to work weekends, holidays, and overtime. Must be able to work alone without usual support systems immediately available in acute care settings. Must be able to deal with abrupt schedule changes. Must maintain objectivity in coping with the stress of working with acute, chronic, and terminally ill patients."