Asst Dir, Qual&Compliance,EIOH

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

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ESSENTIAL FUNCTIONS

• Directs the implementation of quality improvement efforts designed to improve clinical performance and maintain compliance with NYSDOH, JCAHO, HIPAA, and other accreditation standards.
• Works collaboratively with quality leadership, quality team, social work, faculty, risk management, and other senior leadership to develop short- and long-term goals and objectives that are in alignment with the Medical Center and department goals.
• Directs and monitors key performance indicators (KPIs) to assess the effectiveness of quality improvement efforts.
• Analyzes data trends to identify areas for improvement and implement data-driven decision-making processes.
• Guides leadership on dental quality policies and initiatives.
• Develops programs and processes to manage complaint cases brought to regulatory authorities and develops process improvements to avoid future complaints.
• Directs compliance with regulatory and accreditation requirements for monitoring and evaluation of patient care, incident reporting/review, risk management, safety management, and education processes and the coordination of record management.
• Provides direction to ensure departments meet the requirements of applicable laws, regulations and standards related to clinical operations and billing compliance.
• Directs the response and follow-up to adverse events, patient harm, and near misses.
• Works collaboratively with the URMC Chief Compliance Officer, EIOH Medical Director, and UR Office of Counsel to facilitate the execution of the Root Cause Analysis (RCA) process.
• Oversees, directs, delivers all information to the NYS Health Commerce System and Health Emergency Response Data System, including but not limited to, patient transfers, RCAs, and employee vaccination status.
• Manages responses to certain requests for medical record and/or subpoenas from the NY Department of Health Information, CMS, and OIG.
• Works collaboratively with Health Information Management on cases that include both dental services and medical care, encompassing electronic health record systems. Oversees internal review of clinical billing to determine compliance with billing policies and procedures, including in-depth reviews of dental and medical record chart documentation, to ensure compliance with HCFA guidelines and chart documentation supports the designed billing level.
• Serves as the primary point of contact for federal, state, and governmental agency queries and audits, including those conducted by appropriate subcontractors.
• Develops policies and procedures and utilizes communication skills that encourage managers and employees to report safety concerns, near-misses, suspected fraud, and other improprieties without fear of retaliation.
• Enforces disciplinary guidelines through well-developed and communicated policies. Manages the investigation of all reports submitted through RL Solutions.
• Provides leadership and training to department faculty on the operations of respective emergency medical response teams. Co-chairs the EIOH Safety Committee with the EIOH Medical Director.
• Establishes and administers a process for receiving, documenting, tracking, investigating, and acting on all patient complaints.
• Works closely with EIOH leadership and offices as needed.
• Oversees, directs, delivers, and/or ensures delivery of a multifaceted educational and training program that focuses on all elements of the quality and compliance program and seeks to ensure all appropriate employees, students, residents, faculty and management are knowledgeable and compliant with pertinent federal and state standards.
• Interviews, hires, and trains assigned staff; plans and directs work, rewards and disciplines employees.
• Regularly shares and communicates information and goals to staff. Develops and manages the OQIC budget.
• Maintains current knowledge of best practices and developing trends in quality and compliance, state and federal regulations, and risk management through networking and participation in state and national organizations and incorporates such into department programs.
• Utilizes dental expertise to contribute to policy development across UR Medicine through active participation in committees, such as URMC Joint Meeting on Quality of Care, URMC Compliance, etc.

Other duties as assigned.

MINIMUM EDUCATION & EXPERIENCE

• Bachelor's degree and 5 years of relevant experience, including at least 2 years of clinical or quality experience required
• Master's degree preferred
• Or equivalent combination of education and experience
• Clinical background as a registered nurse preferred

KNOWLEDGE, SKILLS AND ABILITIES

• Strong communication, analytical and data management skills preferred
• Ability to work collaboratively with providers, organizational leaders, and department leadership preferred
• Ability to lead and motivate cross-functional teams preferred
• Familiarity with healthcare and regulatory standards preferred

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion/creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Classes). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates for all persons consistent with our values and based on applicable law.