Senior Director of Quality and Risk
Location
Silver Spring, MD | United States
Job description
CCI Health Services’ mission is to deliver high quality, accessible care to our community members, leading the way to a more equitable health care system for everyone.
Position Summary
The Senior Director of Quality and Risk will play a key role in shaping and maintaining the Quality Assurance, Quality Improvement and Risk Management strategies for CCI Health Services. Reporting directly to the Chief Medical Officer, this position will oversee the Director of Population Health and Clinical Quality as well as the Risk Manager position and will be responsible for overseeing all new and ongoing activities related to development, implementation, maintenance of, and adherence to CCI policies and procedures covering the privacy of and access to protected health information (PHI) in compliance to federal and state laws and health system privacy practices. The Senior Director of Quality and Risk ensures that periodic risk assessments and ongoing monitoring of key elements of the privacy program are monitored, including privacy notice, consent, authorization, business partner agreements/practices, minimum necessary information, and disclosure.
The Senior Director of Quality and Risk oversees compliance functions, manages Quality Assurance, oversees quality of billing practices, and conducts EMR/medical review records to ensure compliance. This position is responsible for professional level management activities including compliance with internal, state, and federal regulations, the provision of high quality, cost-effective patient care and the reduction of funding disallowances from funding sources due to improper charting and billing. Compliance monitoring includes state Medicaid, Medicare, commercial insurances, Americans with Disabilities Act, and all associated state and federal regulations through the utilization review, quality improvement, cultural competency, fiscal operations and medical records programs and activities for all medical programs within CCI.
KEY FUNCTIONS AND RESPONSIBILITIES - Strategic Leadership:
- Develop and implement a comprehensive quality assurance and risk management strategy aligned with organizational goals and regulatory requirements.
- Prepare and implement Quality Assurance and Performance Improvement Work Plans.
- Provide strategic guidance to the quality and risk management teams for continuous improvement.
- Maintain direct responsibility for the management of and troubleshooting for documentation within an electronic health record.
- Team Management:
- Supervise and support the Director of Population Health and Clinical Quality and the Risk Manager, and their teams to foster a collaborative and results-driven team culture.
- Conduct regular performance evaluations and professional development initiatives for QA/QI/Risk teams.
- Conduct regular meetings with clinical staff to provide feedback of internal audits and implement corrective action as necessary to achieve required conformance.
- Quality Improvement:
- Co-chair monthly quality improvement committee meetings, collaborating with key stakeholders to identify areas for improvement and develop action plans, including quality improvement and performance improvement work plans.
- Implement evidence-based practices to enhance the quality and safety of patient care across all clinical services.
- Risk Management:
- Co-chair quarterly risk management meetings, overseeing the identification, analysis, and mitigation of potential risks.
- Collaborate with departments to implement risk reduction strategies and ensure compliance with risk management policies.
- Works with legal counsel and management, key departments, and committees to ensure the organization has and maintains appropriate privacy and confidentiality consent, authorization forms, and information notices and materials reflecting current organization and legal practices and requirements.
- Oversee the Grievance and Appeal process and the Patient Rights Advocate for all client complaints, including requests for confidential patient information.
- Plan and implement ongoing and periodic documentation reviews of CCI’s Medical Department.
- Regulatory Compliance:
- Stay informed about changes in healthcare regulations and accreditation standards related to quality and risk management.
- Oversee all documentation procedures & requirements for records and reporting compliance, conducting, and reporting on internal audits.
- Ensure organizational compliance with all relevant regulatory requirements by working closely with Program Directors in developing program policies which meet federal, state, and local government, as well accrediting body’s requirements.
- Provides development guidance and assists in the identification, implementation, and maintenance of organization information privacy policies and procedures in coordination with senior and executive management teams.
- Works with legal counsel and management, key departments, and committees to ensure the organization has and maintains appropriate privacy and confidentiality consent, authorization forms, and information notices and materials reflecting current organization and legal practices and requirements.
- Establishes and administers a process for receiving, documenting, tracking, investigating, and taking action on all complaints concerning the organization's privacy policies and procedures in coordination and collaboration with other similar functions and, when necessary, legal counsel.
- Participate with internal, external and partner agencies regarding compliance issues including regulatory, fiscal, and operational policies.
- Data Analysis and Reporting:
- Oversee the collection, analysis, and reporting of quality and risk-related data.
- Review, evaluate, introduce, and monitor outcomes relating to benchmarks, regulatory procedures and quality improvement.
- Present findings to leadership and stakeholders, providing insights for decision-making.
- Plan for, oversee and respond to any annual External Quality Review Organization reviews, JACHO, DHHS, PCMH, HRSA, SAMHSA as assigned.
- Continuous Education:
- Facilitate ongoing education and training programs for staff on quality improvement and risk management principles.
- Keep the organization informed about emerging trends and best practices in quality and risk management.
MINIMUM QUALIFICATIONS - Bachelor’s degree in healthcare administration, risk management, or a related field; Master’s degree preferred.
- Certified Professional in Healthcare Risk Management (CPHRM) certification is a plus.
- Minimum of 5 years’ experience in risk management within a healthcare setting
- Strong knowledge of healthcare regulations, accreditation standards, and risk management principles.
- Excellent analytical, communication, and problem-solving skills with the ability to collaborate effectively with cross-functional teams.
- Supervisory experience required.
WHY WORK AT CCI?- Extensive benefits plan
- Generous PTO Plan
- 403B Retirement Plan + Employer match up to 4%
- Tuition Reimbursement
- Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
- Our providers are insured for malpractice under the Federal Tort Claims Act.
** CCI Health Services is an Equal Opportunity Employer ** Founded in 1972, CCI Health Services is a diverse and inclusive workplace grounded in community. Located in the Washington, DC Metro Area, each year CCI cares for more than 60,000 individuals in Montgomery and Prince George’s Counties. As a non-profit, CCI is committed to improving health equity through the provision of affordable primary care for all, across all stages of life. Visit ccicares.org for more information.
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