Job Summary:
The Director of Quality and Compliance directs the internal administrative initiatives necessary for the Agency to accomplish the delivery of safe, cost-effective, high-quality patient care in the home environment. The Director leads and integrates the Quality Management functions (Performance Improvement, Risk Management, Patient Safety, Infection Control, Data Chart Abstraction, and Survey Readiness and Preparation), coordinates regulatory surveys for the organization, and provides general oversight of agency licensure, accreditation, and payor/provider credentialing. The Director serves as the subject matter expert for clinical and regulatory compliance, acts as the compliance escalation point for the agency, and serves as risk manager, providing oversight into best practices for the mitigation of disaster risk. This position directly oversees the Quality and Compliance functions and maintains a collaborative partnership with all company departments to ensure alignment with regulatory, accreditation, and QAPI requirements.
Location: On-Site - Missoula, MT
Schedule: Typically Monday - Friday 8:00am-5:00pm
FTE: 1.0 - Full-Time
Essential Duties and Responsibilities:
- Develops and implements the organizational quality assurance/performance improvement (QAPI) program and identifies Key Performance Indicators (KPIs) through analysis of data, observation of operations, and consultation with leadership, staff, and other stakeholders.
- Leads and integrates Performance Improvement, Risk Management, Patient Safety, and Data Chart Abstraction; plans, organizes, and implements new programs and processes in these areas.
- Maintains direct oversight of, and deep involvement in, the infection control program, which is led by the Administrative Compliance Supervisor.
- Provides heavy insight and assistance to the Supervisor of Quality & Compliance, who performs utilization review, clinical chart audits, and routine completion of survey plans of correction (POCs).
- Coordinates with Directors and Managers to ensure QAPI efforts are integrated into all operations and departments, including staff responsibilities.
- Leads performance improvement projects (PIPs) and provides education and coaching to build needed skills in others to lead PIPs. Encourages staff member involvement in QAPI.
- Provides oversight, planning and coordination of Quality management activities, including patient care reviews, compliance audits, and concurrent and retrospective clinical record reviews. Analyzes trending on utilization, outcome and quality data.
- Analyzes and reports key quality indicators to include trend analysis; organizes and facilitates the agency's QAPI/Compliance Committee and prepares regular reports to document progress of QAPI/compliance activities and for review by the agency's governing body, CEO, and agency leadership.
- Leads survey readiness and preparation and coordinates all regulatory and accreditation surveys for the organization, including oversight of corrective action plans.
- Oversees and monitors implementation of the agency compliance program including HIPAA and medical records compliance. Serves as the organization's Compliance Officer and HIPAA Privacy Officer. Serves as the subject matter expert for Medicare, Medicaid, private insurance coverage requirements, accreditation standards, and conditions of participation.
- Provides general oversight of agency licensure, accreditation, PECOS management, Medicaid revalidation, and payor/provider credentialing.
- Monitors performance on CMS quality reporting and value-based programs (e.g., HHVBP, CAHPS, PEPPER) and leads the organization's response to payer and regulatory audits (e.g., ADR, RAC, TPE).
- Uploads OASIS & HOPE data per CMS requirements and downloads applicable iQIES reports for use in QAPI initiatives for home health and hospice.
- Acts as the subject matter expert for OASIS and HOPE integration and its impact on patient care and agency function. Possesses expert knowledge of the clinical information system and oversees maintenance of the system tables related to clinical documentation, care planning, and standards of care.
- Oversees the organization's policy and procedure framework with program directors, including development and revision, and evaluates operations for compliance with accreditation and regulatory standards.
- Collaborates with physician groups to evolve continuum-based care protocols for commonly serviced diseases, which may integrate advanced technology such as telehealth. Facilitates process flow design to increase efficiency using Lean practices.
- Directs annual disaster drill activities and coordinates risk related educational offerings, participates in community disaster planning and coordination through the LEPC committee.
- Partners with Education leadership, operations Directors, and Program and Clinical Managers on competency assessment and professional development so that staff education reflects QAPI findings, evidence-based practice, and regulatory requirements.
- Directly supervises the Administrative Compliance Supervisor and the Supervisor for Quality & Compliance, including feedback, assessment, and disciplinary action when necessary.
- Performs other duties as assigned by CEO.
Required Skills and Abilities:
- High degree of skill in organization and time management and in operating efficiently within budgetary constraints; ability to plan, organize, and implement new programs and processes.
- Ability to collect, organize, and evaluate statistical data and to format information for presentation to others. Competency in data collection, data analysis methodology, and performance improvement methods.
- Maintains a high degree of confidentiality in all matters and manages sensitive situations with tact, professionalism, and diplomacy.
- Demonstrated skills in written and oral communication, supervision of staff, documentation requirements, service coordination, and case management. Excellent interpersonal, teaching, and group facilitation skills.
- Computer proficiency and working knowledge of Microsoft programs required; ability to learn new computer software applications.
Preferred Qualifications:
- Advanced degree in a related health care field.
- Five or more years of experience in home care and quality improvement, including at least 2 years of managerial/executive level experience, preferably in home health/hospice.
- Experience with medical EMRs, preferably HCHB, Elation, and/or CareTend.
- Professional certification in quality, compliance, or clinical documentation (e.g., CPHQ, CHC, HCS-D, COS-C).
