Description

JOB PURPOSE & MISSION

Reports to the Board of Directors (or its designated Board Compliance Committee) and is responsible for the development, coordination, implementation, and oversight of the Compliance Program.

Essential Job Functions include, but are not limited to:

1. Develop, coordinate, implement and oversee the Compliance Program.

• Ensure the Compliance Program meets current legal requirements.
• Align the Compliance Program with policies and procedures and all applicable laws and regulations.
• Promptly issue a report to the Executive Leader and Clinical Oversight Pharmacist.
• Provide periodic reports to the QMC regarding the nature, progress and status of the Compliance Program and related activities.
• Monitor applicable regulatory and legislative changes and revise the Compliance Program accordingly.
• Ensure compliance with URAC and ACHC accreditation requirements.
• Maintains all records in an orderly fashion.

2. Oversee a process to promptly investigate compliance concerns and violations and maintain written documentation regarding each alleged violation and the results of each investigation.

• Conduct or authorize independent investigations of compliance matters when appropriate.
• Communicate and collaborate with appropriate personnel to resolve compliance issues, consulting with outside experts as necessary.
• Assess compliance risk and ensure that the organization is responsive to those risks.
• Make reasonable efforts to maintain the anonymity and/or confidentiality (if requested) of the identity of an Employee who senses guidance or reports suspected misconduct.
• Describe the nature of the allegations, the discovery of information obtained during investigation, the Compliance Officer's findings, and any remedial and/or disciplinary measures taken or recommended.
• Cooperate with internal and external auditors and reviewers to honestly, accurately, and completely provide information designed to ensure the integrity of audit and review processes.
• Work with Human Resources in the determination and implementation of appropriate sanctions for compliance violations.

3. Optimize the effectiveness of the Compliance Program, including integration of compliance activities throughout the organization.

• Advise the QMC regarding compliance priorities and resource allocation.
• Successfully lead quarterly compliance meetings with QMC and staff.
• Serve as a staff pharmacist as required to meet operational needs.
• Perform MTMs as needed to optimize patient medication regimens and improve health outcomes.

4. Oversee a program of compliance education and training for Employees.

• Provide a copy of the Code of Conduct and Compliance Program to each Employee.
• Maintain a complete set of all original Compliance Certificates from all Employees.
• Serve as a knowledgeable resource for organizational compliance issues.

5. Performs all other duties as assigned.

• Maintains competency required for current job title/position.

JOB REQUIREMENTS

Experience

Required: 2 years of pharmacy experience

Education

Required: PharmD degree

Certifications & Licensure

Required: Current Pharmacist License from the Louisiana Board of Pharmacy

Special Skills or Knowledge

Required:

• Working knowledge of the clinical aspect of a medical practice
• Understanding of medical reimbursement specific to coding, Medicare, and third-party payor regulations, along with Medicare compliance and HIPAA
• Possess strong communication skills; both verbal and written
• Demonstrates time management, organizational, and team-building skills
• Ability to interact positively with physicians, staff, and patients
• Strong computer skills
• Ability to work in a fast-paced and stressful environment

HIPAA & SAFETY REQUIREMENTS

HIPAA - Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to Job Position including but not limited to: Medical records without limitation both paper and electronic, patient demographics, lab and radiology results, patient information related to surgery or appointment schedules, medical records related to quality data, patient financial information, patient billing 3rd party, patient related complaints, information related to patient location, religious beliefs and/or public health records.

SAFETY - Maintains knowledge of and adherence to all applicable safety practices appropriate to Job Position including but not limited to: Incident reporting, handling of wastes, sharps and linen, PPE, exposure control plans, hand washing, environment of care, patient identification, administers/collects medications/blood order, transports/monitors or observes patients with infusion pumps, and monitors clinical alarms.

PHYSICAL DEMANDS

Ability to regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 20 pounds, and occasionally lift and/or move up to 50 pounds. Ability to work varied hours/days and overtime as business dictates. Ability to operate computer, phone, copier, fax and calculator and other office equipment. Must be able to exert well-paced ability in limited space. Requires grasping, writing, standing, sitting, walking, repetitive motions, bending, climbing, listening and hearing ability and verbal acuity. Talking and hearing occur continuously in the process of communicating with customers and other employees. Vision occurs continuously with the most common visual functions being those of near vision and depth perception. Requires manual dexterity to use and operate all necessary equipment.

PERFORMANCE CRITERIA & STANDARDS

Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.

• Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
• Takes initiative in living our Everyday Excellence values and vital signs.
• Takes initiative in identifying customer needs before the customer asks.
• Participates in teamwork willingly and with enthusiasm.
• Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
• Keeps customers informed, answers customer questions and anticipates information needs of customers.

Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines and the GHS Corporate Compliance Guidelines.

• Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
• Maintains accurate and reliable patient/organizational records.
• Maintains professional relationships with appropriate officials; communicates honestly and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.

Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.

• Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
• Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
• Upholds the ethical standards of the organization.

Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.

• Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
• Initiates or redesigns to continuously improve work processes.
• Contributes ideas and suggestions to improve approaches to work processes.
• Willingly participates in organization and/or department quality initiatives.

Cost Management - Employee demonstrates effective cost management practices.

• Effectively manages time and resources.
• Makes conscious effort to effectively utilize the resources of the organization - material, human, and financial.
• Consistently looks for and uses resource saving processes.

Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.

• Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
• Employee proactively reports errors, potential errors, injuries or potential injuries.
• Employee demonstrates departmental specific patient and employee safety standards at all times.
• Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.