General Information
| Payroll Title | UNCLASSIFIED | Title Code | 009999 | Grade/Step | 11 | Working Title | Compliance Manager |
|---|---|---|---|---|---|---|---|
| Department Name | SOM Compliance Dept | Supervisor | Paul H Hackman | Department Head | Deborah V Deas |
Special Requirements and Conditions
| Critical Position |
| Travel |
| Travel Outside of Normal Business Hours |
Level of Supervision Received
| General Direction |
Items Used
| Typical office environment. |
Position Purpose
| UCR Health is a team of physicians, specialists and healthcare professionals dedicated to improving the health of Inland Southern California residents and families by bringing health home to our communities. Established alongside the School of Medicine at the University of California, Riverside, UCR Health is growing to meet the healthcare needs of the region - bringing innovative, culturally sensitive medical care to our communities. Our patient-centered primary care and specialty services deliver university-based healthcare excellence and innovation to the communities where we live, work and play. To learn more about UCR Health, please visit: www.ucrhealth.org The Compliance Manager will contribute to the establishment of our infrastructure, growth and success in meeting our mission by supporting and maintaining a comprehensive and effective compliance program. The Compliance Manager manages compliance reporting requirements, develops and maintains auditing and monitoring processes as assigned. Responsible for the timely and consistent coordination of complex investigations (high volume and/or high risk). In collaboration with the Director of Compliance and Privacy, implements, monitors and maintains a privacy compliance framework to identify risks, trends, outcomes that support the consistent assessment, remediation and reporting of certain privacy compliance risks across the UCR enterprise. Recommends, initiates implementation of remediation activities, and monitors progress of action plans as assigned. Please note: The classification title and salary range for this position are currently under review. The candidate will be placed on the anticipated salary range of $59,965 - $125,706. |
Essential Functions
| Essential Function | % Time |
|---|---|
| Investigations / Audits / Reviews | 30 |
| Performs special audits and investigations as deemed necessary through collaboration with the Director of Compliance/Privacy Officer. Coordinates and participates investigations and reviews related to compliance and privacy. Conducts research of applicable federal and state regulations to provide preliminary analysis of problem and recommend interaction at various levels in the organization. In response to investigations, audits, and reviews, assists key stakeholders in developing measurable action plans and monitors the progress, assesses for re-evaluation, and completion of the action plans. Maintains the routine audit processes (clinical, regulatory, use of protected health information (PHI), vendor, etc.). Determines when focused audits are appropriate. Designs auditing and sampling methodologies for professional compliance; ensures the quality and accuracy of audits performed by the compliance office. Acts as a liaison with the departments served by the compliance office. Collects, prepares, and reports on metrics to identify trends and address issues/concerns. Coordinates with the Director of Compliance/Privacy Officer, to respond to inquiries needing regulatory analysis or guidance, such as allegations, concerns and complaints communicated directly to the compliance office or from another entity. Analyzes trends, and evaluates program requirements and resource utilization; coordinates program planning and evaluation; coordinates protocols to affect integrated services with other programs, departments and agencies; responds to requests for information. Reviews and approves documents, clinical files and billing records for all programs. Works closely with the information technology department to review new system implementations. |
|
| Regulatory and Policy Compliance | 30 |
| Ensures accountability for compliance through risk assessment, problem identification, oversight & monitoring, investigation and follow ups. Assists in evaluating the adequacy of processes to help ensure compliance with applicable federal and state statutes, laws, regulations and established policies. Prepares and responds to licensing and accreditation entities - understand the applicable standards, review policies, and develop and monitor action plans. Develops and revises policies and supporting forms - investigate best practices, collaborate with key stakeholders and subject matter experts, and present to committee. Develops and enhances cooperative professional relationships with local community agencies. Leads, or provides assistance to those who lead, investigations into alleged noncompliance with policies and procedures. Provides guidance, policy interpretations and recommendations to employees, faculty, and affiliates. Oversees functions to ensure appropriate record creation, filing, tracking, and data spreadsheets are maintained on department activities. Assists in preparation of responses and reports to various external entities and agencies as required. Composes, edits, and proofreads a variety of correspondence, policies, documents, reports. Proofreads outgoing communications for accuracy and completeness. Serves as the primary contact for reviewing vendor reports of potential or existing vendors who have been reported on the sanction lists. Investigate to determine whether the name on the sanction list and vendor are the same. |
|
| Process Improvement | 10 |
| Conducts clinical and business process and systems reviews to identify process improve and process re-engineering. Collaborates with all levels of leadership to formulate action plans for remedial or corrective action. Monitors the progress and completion of said action plans. Creates a continuous process improvement plan and documents for each line of clinical and business operations that clearly outlines best practices and processes for the organization. Champions continuous improvement by building strong networks for promoting quality and process improvement within the entire organization. |
|
| Committees | 5 |
| Represents the School of Medicine and identified initiatives when participating in various committees with the campus departments: compliance, legal, risk management, environmental health and safety, research. Provides regular reports to various enterprise committees with oversight or advisory responsibility for the compliance department. |
|
| Other and Travel | 5 |
| Travels to multiple clinic sites and university locations. Performs other assignments/projects as assigned. |
|
| Annual Work Plan | 5 |
| Participates in the development of the annual work plan for the Compliance Office with the primary responsibility for the work plan for the professional unit. | |
| Medical Records Administration | 5 |
| Assists with establishing mechanisms to document the accounting of patient medical records. Reviews subpoenas and patients requests for patient medical information. Determines whether information can be released and prepare response to the request and copies in accordance with regulatory requirements. Determines compliant storage of patient medical records and confidential information. Serves as primary contact with vendor. |
|
| Education and Training | 5 |
| Provides or oversees the provision of training to physicians and staff on compliance matters, oversee and/or conduct compliance investigations when necessary. Conducts routine and focused educational programs in professional compliance. Manages the conduct of routine professional compliance education and training. Coaches and trains the leadership team and designated employees in the use of tools, techniques and methods to deliver on continuous improvement. |
|
| Supervision | 5 |
| Supervises activities and evaultes the performance of direct reports. | |
Minimum Requirements
| Minimum Requirement | Display Ranking |
|---|---|
| 1 | |
| Bachelor's degree in a related field from an accredited institution or equivalent credentials. | |
| 2 | |
| A minimum of 5 years experience working in a health care organization, including experience in a healthcare privacy, quality or analytical environment or an equivalent combination of education and experience. At minimum one of these years must be in a healthcare compliance department position. Experience in a healthcare setting overseeing and implementing investigatory/compliance process management and audit/investigation administration. | |
| 3 | |
| Demonstrated knowledge and understanding of HIPAA rules and regulations affecting the management of confidential protected health information. | |
| 4 | |
| Ability to conduct effective and accurate regulatory research and analysis. Ability to perform analytical tasks and accurate calculations. | |
| 5 | |
| Ability to appropriately prioritize work responsibilities and effectively manage fluctuating workload demands. | |
| 6 | |
| Proficient in Microsoft Office suite applications. | |
| 7 | |
| Project management and quality improvement techniques/methodology including process mapping and work-flow analysis tools experience. Demonstrated ability to develop and manage work plans and to prioritize, organize, and systematically handle a variety of tasks simultaneously. | |
| 8 | |
| Knowledge of medical office practices, procedures and methods; knowledge of EHR applications. | |
| 9 | |
| Excellent critical thinking and problem-solving skills. Advanced communication and interpersonal skills. | |
| 10 | |
| Ability to work effectively with staff/faculty from diverse ethnic/racial backgrounds, educational levels, sexual orientations and identities. Ability to work independently under general direction and to work collaboratively with others. | |
Preferred Qualifications
| Preferred Qualification | Display Ranking |
|---|---|
| 1 | |
|
Certified in Healthcare Compliance (CHC) or will obtain within six months of employment. |
|
| 2 | |
| Extensive knowledge of Privacy Rule and Security Rule standards and other regulatory requirements. | |
| 3 | |
| Prior University of California or Academic Medical Center experience. | |
| Posted Position Purpose |
|---|
| UCR Health is a team of physicians, specialists and healthcare professionals dedicated to improving the health of Inland Southern California residents and families by bringing health home to our communities.
Established alongside the School of Medicine at the University of California, Riverside, UCR Health is growing to meet the healthcare needs of the region - bringing innovative, culturally sensitive medical care to our communities. Our patient-centered primary care and specialty services deliver university-based healthcare excellence and innovation to the communities where we live, work and play. To learn more about UCR Health, please visit: www.ucrhealth.org
The Compliance Manager will contribute to the establishment of our infrastructure, growth and success in meeting our mission by supporting and maintaining a comprehensive and effective compliance program. The Compliance Manager manages compliance reporting requirements, develops and maintains auditing and monitoring processes as assigned. Responsible for the timely and consistent coordination of complex investigations (high volume and/or high risk). In collaboration with the Director of Compliance and Privacy, implements, monitors and maintains a privacy compliance framework to identify risks, trends, outcomes that support the consistent assessment, remediation and reporting of certain privacy compliance risks across the UCR enterprise. Recommends, initiates implementation of remediation activities, and monitors progress of action plans as assigned.
Please note: The classification title and salary range for this position are currently under review. The candidate will be placed on the anticipated salary range of $59,965 - $125,706. |
| Posted Minimum Requirements |
| Bachelor's degree in a related field from an accredited institution or equivalent credentials. Minimum of 5 years experience working in a health care organization, including experience in a healthcare privacy, quality or analytical environment or an equivalent combination of education and experience. At minimum one of these years must be in a healthcare compliance department position. Experience in a healthcare setting overseeing and implementing investigatory/compliance process management and audit/investigation administration. Certification as CSC-P. Demonstrated knowledge and understanding of HIPAA rules and regulations affecting the management of confidential protected health information. Ability to conduct effective and accurate regulatory research and analysis. Ability to perform analytical tasks and accurate calculations. Ability to appropriately prioritize work responsibilities and effectively manage fluctuating workload demands. Proficient in Microsoft Office suite applications. Project management and quality improvement techniques/methodology including process mapping and work-flow analysis tools experience. Demonstrated ability to develop and manage work plans and to prioritize, organize, and systematically handle a variety of tasks simultaneously. Knowledge of medical office practices, procedures and methods; knowledge of EHR applications. Excellent critical thinking and problem-solving skills. Advanced communication and interpersonal skills. Ability to work effectively with staff/faculty from diverse ethnic/racial backgrounds, educational levels, sexual orientations and identities. Ability to work independently under general direction and to work collaboratively with others. |
| Posted Preferred Qualifications |
| Certified in Healthcare Compliance (CHC) or will obtain within six months of employment. Extensive knowledge of Privacy Rule and Security Rule standards and other regulatory requirements. Prior University of California or Academic Medical Center experience. |