Quality Risk Specialist

The Quality Risk Specialist, as part of daily duties, will assist the QI Director in the planning and implementation of a systemic program for risk management and compliance at CRCHC, including policy and training development related to quality, risk, patient care, and employee safety. The position serves as primary administrative and reporting support to QI Director in the monitoring and evaluation of processes for quality, risk management, safety, and compliance. This position exists to ensure compliance with internal initiatives and external regulatory requirements. In addition, the Risk Coordinator may serve as a team facilitator and consultative resource for clinical and departmental leadership and staff responsible for quality, risk, and compliance improvement activities at CRCHC. This individual is responsible for the management and processing of claims related activities as directed by the CEO.

Key Responsibilities

1. Develop and implement a strategic approach and monitoring programs for organizational-wide compliance with regulatory agencies (i.e. NCQA, State, local, OSHA).

2. Provide clerical and reporting support to QI Director for meetings and presentations.

3. Generate periodic reports from EHR to support clinical quality and risk management activities.

4. Develop, oversee, monitor and evaluate the effective implementation of the CRCHC Risk and Safety Program.

5. Keep abreast of changes in applicable rules, regulations, standards and related trends that are relevant to the Risk and Safety Program and make necessary modifications to policies and procedures.

6. Assist in the establishment and monitoring of information privacy policies and procedures in coordination with management and legal counsel to ensure HIPAA compliance.

7. Ensure proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.

8. Assist and provide guidance to staff with risk management, safety, and compliance projects.

9. Perform, communicate, and monitor internal safety/compliance audits on a periodic basis. Based on findings, determine training needs of the organization.

10. Gather, analyze, and monitor patient feedback (comments, complaints, and grievances) on a periodic basis, which may include taking phone calls about patient complaints

11. Collect data to identify problems or weaknesses in CRCHC procedures and work with QI Director to improve areas identified.

12. Facilitate a culture of safety in the organization that creates an atmosphere of mutual trust for staff to talk about safety problems and solutions.

13. Draft, report, and monitor adverse events, near misses, and potentially unsafe conditions. Based on findings, determine training needs of the organization.

14. Refine and monitor emergency management and organization safety plan. Serve as the point of contact for external community partners (i.e. Fire, Safety, etc.).

15. Provide additional administrative support to all quality improvement department projects and initiatives.

16. Support current incentive, regulatory, and certification requirements (such as Meaningful Use, PCMH and UDS) through documentation, participation in initiatives, and other activities as directed.

17. Performs other duties as assigned.