Compliance Manager

Education 

Qualifications 

Experience 

Education: A Bachelor’s degree required; Master’s desired. 

Experience: A minimum of 5 years’ experience in a healthcare organization, to include demonstrated leadership. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must. 

Qualifications: 

Successfully pass criminal records check, finger printing, and HCPR check as a prerequisite for employment consideration. 

Must successfully complete all core required trainings and updates as needed. 

Must have reliable transportation, maintain required level of vehicle insurance and valid driver’s license. 

Must be available to travel. 

Auditor Skills and Qualifications: 

Receive training in population served, and client’s rights/confidentiality.  

Complete CTS Orientation.  

Experience with HIPAA  and System Of Care is required.  

The employee must become privileged/credentialed in delivery of services.  

CPR/First Aid, Medication Administration and Preventive Disease will be required.  

Code of Ethics  

Risk Management 

Investigation and Resolution 

Health Care Organization 

Human Resource Procedure  

QA/QI 

Leadership Training 

Employment Services 

Internal Auditing  

Plan Of Correction Training 

Auditor Skills and Qualifications: 

Knowledgeable about CARF, State, Federal, and Agency Compliance, Documentation Skills, Attention to Detail, Reporting Research Results, Thoroughness, Excellent Written and Verbal Communication, Presentation Skills, Professionalism, Objectivity. 

Auditor Job Duties: 

• Ensures compliance with established external and internal control procedures by examining records, reports, operating practices, and documentation. 

• Verifies compliance through comparison of documentation to established policies, procedures and regulations. 

• Completes audits through hands-on, on-site review of consumer and employee charts, office inspections, and preparing Plan of Correction and follow-up. 

• Appraises adequacy of internal control systems by completing audit checklists. 

• Maintains internal control systems by updating audit programs and checklists; recommending new policies and procedures. 

• Communicates audit findings by preparing quarterly reports; discussing and presenting findings with Executive Team. 

• Complies with federal, state, and local legal program requirements by studying existing and new legislation; enforcing adherence to requirements; advising management on needed actions. 

• Prepares special audit and control reports by collecting, analyzing, and summarizing operating information and trends. 

• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks. 

• Contributes to team effort by accomplishing related results as needed. 

Compliance Job Responsibilities: 

The Compliance Officer oversees the Corporate Compliance Program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. The position ensures the Board of Directors, management and employees are in compliance with the rules and regulations of regulatory agencies, that company policies and procedures are being followed, and that behavior in the organization meets the company’s Standards of Conduct/Ethics. 

The Corporate Compliance Office exists: 

• As a channel of communication to receive and direct compliance issues to appropriate resources for investigation and resolution, 

• As a final internal resource with which concerned parties may communicate after other formal channels and resources have been  exhausted. 

Responsibilities and Duties 

• Develops, initiates, maintains, and revises policies and procedures that have been approved by the BOD for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct. Manages day-to-day operation of the Program. 

• Develops and periodically reviews and updates Code of Conduct/Ethics to ensure continuing currency and relevance in providing guidance to management and employees. 

• Collaborates with other departments (e.g., Risk Management, Internal Audit, Employee Services, etc.) to direct compliance issues for investigation and resolution. Consults with the Corporate attorney as needed to resolve difficult legal compliance issues. 

• Responds to alleged violations of rules, regulations, policies, procedures, and Code of Conduct/Ethics by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations. 

• Acts as an independent review and evaluation body to ensure that compliance Issues/concerns within the organization are being appropriately evaluated, investigated and resolved. 

• Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends. 

• Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future. 

• Provides reports on a regular basis, and as directed or requested, to keep the Corporate Compliance Committee of the Board and management informed of the operation and progress of compliance efforts. 

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

• Establishes and provides direction and management of the compliance Hotline. 

• Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures. 

• Works with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.   

• Reports non-compliance matters to Human Resources and makes recommendations regarding Performance Improvement Plan. 

• Monitors the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness. 

Communication: 

• Work with a team approach with other employees to ensure agency compliance. 

• Report critical concerns and problems to Supervisor in a timely manner and actively seek Supervisor’s input and assistance to  resolving the concern.  

• Follow chain of command when encountering problems or other areas of need and correct problems requested. 

• Solicit and cooperate with assistance of all support staff. 

• Actively participate in an appropriate manner with the decision-making process as “pro-active” team member and cooperate  with team’s decision, whether programmatic or clinical.  

• Provide coverage on-site or as assigned by the needs of the agency.  

• Attend staff meetings, planned in-service training, on-going training and any other regular or assigned meetings. 

• Responsible for any equipment assigned in order to perform duties.  

• Facilitate flow of information. 

Hours of Work:  

• Full-time position requirement of a minimum of 36 hours per week on-the-job. 

• Self-monitor the use of own time and the time of co-workers if it affects this position in the areas of work hours, schedule, breaks, lunches, etc. Report any needs in this area to the supervisor and/or “chain of command”. 

• Respond to pages or after hour calls in accordance to procedures.