Job Details: Job Location: Administration – Leesburg, FL, Position Type: Full Time, Education Level: 4 Year Degree, Salary Range: $39.19, Job Shift: Day, JOB SUMMARY: Responsible for the coordination, implementation, and oversight of LifeStream's Risk Management and Corporate Compliance Programs. Supports organizational efforts to identify, assess, monitor, and mitigate organizational and regulatory risk while promoting compliance with federal, state, accreditation, contractual, privacy, and payer requirements. Provides leadership and oversight for corporate compliance activities, investigations, grievances, privacy and confidentiality matters, claims management, organizational liability reduction, regulatory reporting, and healthcare risk management initiatives._x005F_x000D_
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Collaborates with operational, clinical, and administrative leadership to foster a culture of integrity, accountability, compliance, ethical conduct, and continuous improvement while protecting the organization's consumers, employees, reputation, assets, and regulatory standing._x005F_x000D_
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Works in partnership with the Director of Safety, Emergency Management & Environment of Care, who maintains responsibility for operational safety functions including safety management, security, workplace violence prevention, emergency management, life safety, environment of care, OSHA compliance, utility management, fire and disaster preparedness, environmental rounding, and safety training programs._x005F_x000D_
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The primary focus of this position is corporate compliance oversight, healthcare risk management, investigations, grievances, privacy and HIPAA compliance, regulatory reporting, claims and liability management, accreditation support, audit activities, and organizational risk reduction._x005F_x000D_
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ESSENTIAL FUNCTIONS and RESPONSIBILITIES: The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification with or without an accommodation. It is not necessarily descriptive of any one position in the class. The omission of an essential function does not preclude management from assigning duties not listed herein if such functions are a logical assignment to the position. _x005F_x000D_
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Risk Management Program Administration_x005F_x000D_
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Coordinate, implement, and oversee the organization's Risk Management Program. _x005F_x000D_
Identify, assess, monitor, and mitigate organizational risks affecting consumers, employees, operations, finances, reputation, and organizational liability. _x005F_x000D_
Maintain oversight of incident reporting systems and risk management processes. _x005F_x000D_
Conduct organizational risk assessments and monitor emerging enterprise risks. _x005F_x000D_
Evaluate organizational practices and services to identify liability exposure._x005F_x000D_
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Corporate Compliance Program Administration_x005F_x000D_
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Coordinate and oversee the Corporate Compliance Program. _x005F_x000D_
Monitor compliance with applicable laws, regulations, payer requirements, contractual obligations, and organizational policies. _x005F_x000D_
Conduct compliance reviews, investigations, monitoring activities, and audits. _x005F_x000D_
Administer compliance reporting mechanisms and ensure appropriate investigation and resolution of reported concerns. _x005F_x000D_
Evaluate the effectiveness of compliance activities and recommend improvements._x005F_x000D_
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Incident, Investigation, and Grievance Oversight_x005F_x000D_
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Direct and oversee investigations involving incidents, adverse events, grievances, complaints, privacy concerns, compliance issues, abuse allegations, and potential organizational liability. _x005F_x000D_
Coordinate root cause analyses and corrective action plans related to compliance, risk, grievances, and organizational liability concerns. _x005F_x000D_
Monitor implementation and effectiveness of corrective actions and mitigation strategies. _x005F_x000D_
Chair the Complaints and Grievance Committee and oversee organizational grievance management activities._x005F_x000D_
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Compliance Hotline and Reporting Program Oversight _x005F_x000D_
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Oversee the Corporate Compliance Hotline and related reporting mechanisms to ensure concerns are received, documented, routed, and addressed appropriately. _x005F_x000D_
Ensure allegations of misconduct, fraud, waste, abuse, privacy concerns, and compliance violations are investigated and resolved appropriately. _x005F_x000D_
Maintain non-retaliation protections for reporting parties._x005F_x000D_
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OIG/SAM Exclusion Monitoring_x005F_x000D_
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Oversee monthly OIG, SAM, Medicaid exclusion, and other sanction screening activities for employees, contractors, providers, interns, board members, and vendors. _x005F_x000D_
Monitor exclusion status and coordinate corrective actions when necessary._x005F_x000D_
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Fraud, Waste, and Abuse Oversight_x005F_x000D_
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Coordinate investigations related to suspected fraud, waste, abuse, billing irregularities, documentation concerns, or misuse of organizational resources. _x005F_x000D_
Partner with Finance, Clinical Operations, and Legal Counsel to address identified concerns._x005F_x000D_
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Contract and Regulatory Compliance Monitoring_x005F_x000D_
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Monitor compliance with federal, state, grant, payer, and contractual requirements. _x005F_x000D_
Coordinate compliance reviews associated with grant-funded and contracted services._x005F_x000D_
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Compliance Work Plan Administration_x005F_x000D_
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Develop and administer the annual Corporate Compliance Work Plan. _x005F_x000D_
Monitor progress on compliance initiatives and report outcomes to executive leadership and the Compliance Committee._x005F_x000D_
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Corporate Integrity and Ethics Program_x005F_x000D_
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Promote organizational ethics, standards of conduct, and corporate integrity initiatives. _x005F_x000D_
Support implementation of the LifeStream Code of Conduct and associated training programs._x005F_x000D_
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Regulatory Reporting and Accreditation Readiness_x005F_x000D_
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Ensure timely and accurate reporting of incidents, adverse events, breaches, investigations, and other required notifications to regulatory, licensing, accreditation, and oversight agencies. _x005F_x000D_
Coordinate compliance readiness activities related to CARF, AHCA, DCF, CMS, HIPAA, and other regulatory requirements. _x005F_x000D_
Serve as a liaison and resource during surveys, audits, reviews, investigations, and accreditation activities._x005F_x000D_
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Privacy, Confidentiality, and Information Security Oversight_x005F_x000D_
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Coordinate investigations involving privacy, confidentiality, protected health information, and information security concerns. _x005F_x000D_
Partner with Information Technology, Operations, Human Resources, and Legal Counsel to reduce privacy and security risks. _x005F_x000D_
Monitor compliance with privacy, confidentiality, and information security requirements and recommend corrective actions when necessary._x005F_x000D_
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Sentinel Event and Risk Reduction Management_x005F_x000D_
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Coordinate the investigation, review, and follow-up of sentinel events, serious reportable incidents, abuse allegations, neglect allegations, and other significant events._x005F_x000D_
Promote risk reduction activities through proactive and reactive interventions._x005F_x000D_
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Organizational Liability and Claims Management_x005F_x000D_
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Coordinate organizational response activities related to claims, litigation support, insurance matters, and legal inquiries. _x005F_x000D_
Maintain documentation related to claims, investigations, liability exposure, and organizational risk. _x005F_x000D_
Collaborate with legal counsel and insurance carriers regarding liability issues and claims management._x005F_x000D_
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Leadership Reporting and Consultation_x005F_x000D_
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Develop and maintain organizational risk, compliance, grievance, privacy, and performance dashboards. _x005F_x000D_
Analyze organizational data to identify emerging compliance, quality, privacy, grievance, and liability trends. _x005F_x000D_
Recommend proactive interventions based on identified risk patterns._x005F_x000D_
Prepare and present reports to executive leadership, governing boards, committees, and other stakeholders regarding risk, compliance, grievances, investigations, claims, and organizational liability. _x005F_x000D_
Provide consultation and technical assistance to leadership regarding risk management, compliance, privacy, investigations, and liability concerns._x005F_x000D_
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RESPONSIBILITIES: _x005F_x000D_
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Participate in Quality Improvement Council activities and other organizational committees. _x005F_x000D_
Develop, review, revise, and maintain risk management, compliance, grievance, privacy, claims management, and related policies, procedures, plans, and forms. _x005F_x000D_
Collaborate with Human Resources, Clinical Leadership, Operations, Finance, Information Technology, Quality Improvement, and Legal Counsel regarding organizational risk and compliance matters. _x005F_x000D_
Develop and provide staff education and training related to compliance, privacy, incident reporting, investigations, grievance management, and risk reduction. _x005F_x000D_
Assist programs and departments in developing corrective action plans related to compliance findings, investigations, grievances, and risk mitigation efforts. _x005F_x000D_
Collect, analyze, maintain, and trend data related to incidents, grievances, complaints, compliance findings, investigations, claims, and operational risk indicators. _x005F_x000D_
Monitor industry trends, regulatory changes, accreditation standards, and best practices and communicate relevant updates to leadership. _x005F_x000D_
Serve as Single Point of Contact (SPOC) for Deaf and Hard of Hearing accommodations and complete related reporting requirements. _x005F_x000D_
Complete required voter registration reporting and other assigned regulatory reports. _x005F_x000D_
Maintain records and documentation necessary to support surveys, audits, investigations, accreditation reviews, claims, and legal proceedings. _x005F_x000D_
Promote a culture of integrity, accountability, compliance, and continuous improvement throughout the organization. _x005F_x000D_
Perform other duties as assigned._x005F_x000D_
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Qualifications: KNOWLEDGE AND JOB SKILLS: Understands the array of services provided by LifeStream and has a working knowledge of the specific risks associated with the provision of care for clients, staff and visitors. Maintain database and trend incidents by type, location and frequency. Capable of responding to significant or sentinel events internally and to external agencies such as the Department of Children and Families, the Agency for Health Care Administration, or accreditation body. Able to train staff in risk management procedures and risk reduction methods. Computer knowledge is vital to the satisfactory performance of this position. Understands risk management philosophies and practices, basic statistics, basic computer skills, group leadership and supervisory skills; the ability to present information in written and oral format. _x005F_x000D_
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PERSONAL QUALITIES: Assertive, objective, detail oriented, good interpersonal skills, and be able to motivate others. _x005F_x000D_
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SPECIAL FACTORS: Must have the ability to interest, to keep abreast of new information, and trends in risk management and related fields. Must maintain Certification as Health Care Risk Manager in Florida. _x005F_x000D_
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JUDGMENT/DECISION MAKING: Utilizes established corporate policies and procedures in making decisions. Uses sound judgment in meeting the responsibilities and performing the duties of the position. _x005F_x000D_
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EDUCATION & EXPERIENCE: _x005F_x000D_
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Education: Bachelor's Degree in Healthcare Administration, Nursing, Risk Management, Public Health, Business Administration, or related field required. Florida Licensed Healthcare Risk Manager (or ability to obtain within one year of hire) required. _x005F_x000D_
Certified Professional in Healthcare Risk Management (CPHRM) preferred._x005F_x000D_
Certified in Healthcare Compliance (CHC) preferred._x005F_x000D_
Certified Professional in Patient Safety (CPPS) preferred._x005F_x000D_
Certified Professional in Healthcare Quality (CPHQ) preferred._x005F_x000D_
Experience: At least three (3) years of risk management or related field combined with three years of clinical and administrative experience in a hospital or mental health setting required. Experience conducting investigations, audits, trend analysis, regulatory reviews, and compliance monitoring required. _x005F_x000D_
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TRAINING & DEVELOPMENT: Completes all requirements according to Individual Training Plan within the first six months of hire and annually. Other training and/or professional development may be assigned due to evolution of programs._x005F_x000D_
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LifeStream Benefits _x005F_x000D_
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Health/Dental/Vision Insurance _x005F_x000D_
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Short Term Disability _x005F_x000D_
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Pension Plan _x005F_x000D_
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403(b) _x005F_x000D_
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PTO (Over 4 weeks your 1st year!) _x005F_x000D_
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Flexible Work Schedules _x005F_x000D_
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Tuition Reimbursement Program _x005F_x000D_
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Free Telehealth Services _x005F_x000D_
HRSA_x005F_x000D_
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And More! _x005F_x000D_
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Important Notice _x005F_x000D_
As part of our hiring process and in compliance with Section 435.04, Florida Statutes, certain positions require a Level 2 background screening. Employment offers are contingent upon meeting applicable requirements. For more details on Level 2 background screening requirements, please visit: Florida Care Provider Background Screening Clearinghouse _x005F_x000D_
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LifeStream is an equal opportunity employer and does not discriminate against any applicant based on age, citizenship, color, covered veteran status, disability, gender identity, genetic information, marital status, race, religion, sex, sexual orientation, or other protected status in accordance with applicable federal, state, and local laws. _x005F_x000D_