Risk Manager jobs at HCA Healthcare

Join the team that is revolutionizing health care - BayCare Health System Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that's built on a foundation of trust, dignity, respect, responsibility, and clinical excellence. Title: Risk Manager - Clinical Risk Management Facility: Morton Plant North Bay Hospital Responsibilities: Responsible for risk management activities, including event management, event analysis, risk assessments, risk education and regulatory readiness in the assigned facility/division. Provides risk reduction recommendations to the organization. Complies with the department policies and procedures. May access patient medical records to perform job functions. Supports physicians and facility leadership in the disclosure to patients and/or family of patients who are subject to an adverse event. Investigates every allegation of sexual misconduct against team members with direct patient contact and reports such events to include, but not limited to, the Department of Health when applicable. Through education and/or experience, the Risk Manager will demonstrate competencies required by Florida Statute. BayCare offers a competitive total reward package including: Benefits (Medical, Dental, Vision) Paid Time Off Tuition Assistance 401K Match and additional yearly contribution Annual performance appraisals and team award bonus Family resources and wellness opportunities Community perks and discounts Experience: Required - 3 years' registered nurse Education: Required - Bachelor's Degree in nursing or related field Preferred - Doctorate Juris Doctor Certifications: Preferred - CPHRM, CPSO, ARM, and CRM Location: New Port Richey, Florida Status: Full Time, Exempt: Yes Shift Hours: 8:00AM - 5:00PM Weekend Work: Occasional Equal Opportunity Employer Veterans/Disabled

The Director of Risk Adjustment is responsible for the strategic design, implementation, and oversight of CCOK's risk adjustment program for both ACA and Medicare Advantage businesses. This individual will coordinate with various areas including IT, Healthcare Economics, Finance, and the Clinical Auditing team in order to maximize the efficiency and effectiveness of Risk Adjustment strategy, analytics, and data reporting to CMS, as well as supporting processes regarding provider education and member engagement to identify opportunities for improved accuracy in coding. KEY RESPONISBILITIES: Develop and execute enterprise-wide risk adjustment strategy to align with regulatory requirements and financial objectives Oversee all aspects of risk adjustment data analytics, including CMS reporting, clinical documentation improvement strategy, and vendor management Lead cross functional teams including coding, analytics, compliance, medical economics and operations to ensure seamless integration of risk adjustment initiatives Monitor and ensure compliance with CMS, Oklahoma regulations, and audit requirements Lead end-to-end timely and accurate submission of risk adjustment data to CMS including overseeing the reconciliation of CMS reports to validate submission accuracy Translate risk adjustment performance into actionable insights to support medical management and quality initiatives Drive innovation and efficiency in risk capture methodologies Partner with finance, actuarial, operations teams to forecast, track performance and manage risk score impacts for all contracted products Collaborate with Clinical Operations on provider education needs to ensure documentation and coding accuracy Evaluate and manage relationships with third party vendors providing risk adjustment services Serve as internal subject matter expert on all aspects of risk adjustment policy changes and risk scoring methodologies Executive level reporting identifying actual to expected performance, outlier trends and prevalence opportunities Promote a culture of accountability, innovation and compliance. Performs other job-related duties as assigned. QUALIFICATIONS: Expert level knowledge of Medicare Advantage and ACA Risk Adjustment reporting lifecycle and submission systems Possesses an insatiable need for process improvement and operational effectiveness Excellent communication, executive presence and relationship building skills Strategic thinker with excellent analytical, critical thinking, problem-solving, interpersonal, and relationship building skills. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: Bachelor's degree in healthcare administration, data science, accounting, finance, or related field; Master's degree MBA, MHA, MPH preferred 10+ years of experience in risk adjustment, Medicare Advantage or related healthcare operations 6 plus years of management experience.

The Manager of Specialized Accounts Receivable provides coordination, leadership and oversight to the VNA Home Health, Hospice and Elder Services AR staff that provide third-party billing, AR follow-up, denials management, underpayment recoupment and credit balance resolution. Coordinates external audits and third-party reviews and works with the Director of Patient Financial Services to meet department AR management and cash collection goals. Researches, develops, and promulgates best practices to ensure that all third-party billing and AR resolution are done timely, accurately, and within compliance to CCHC, payer, state and federal regulations. Supports the training and development of the AR team. Continually seeks improvement in AR Management processes and technology. PRIMARY DUTIES AND RESPONSIBILITIES: Support, oversee, and manage the performance, productivity and quality of the entire Billing, Follow-Up/Denials team as it relates to all AR Management activities and pre-defined and Manager identified goals and targets. Develop, implement, and manage efficient and effective operational policies, procedures, processes and performance monitoring across all third-party AR resolution, denials management, credit balance resolution and payment variance recoupment. Ensure CCHC employees and vendor staff performing AR functions are compliant with policies, procedures and processes; measure and address all areas of non-compliance. Maintain up-to-date knowledge of regulatory and compliance, for state and federal agency, changes impacting billing requirements and operations. Collaborate with other disciplines, IT partner and vendors to implement changes needed to address payer and regulatory billing requirement changes and denial prevention. Ensure vendors and CCHC revenue cycle employees are appropriately educated and trained as well as department policies and processes are modified, as required, to stay current. Work with Managed Care department, payor representative, vendors and all other departments within CCHC and Physician Practices to resolve outstanding account receivable issues Ensure negotiated contracts are being administered and reimbursed according to contractual terms and rates. Assist managed care in the resolution of contract payment issues. Confirm staff are consistently performing performance-monitoring processes. Define, implement, and monitor strategies to improve overall patient financial services processing efficiency. Ensure that denial trends identified are managed and tracked to improvement ensuring mitigation strategies are consistently implemented. Manage to applicable Key Performance Indicators (“KPIs”). Define and implement action plans when performance is not meeting expectations. Assess workflow prioritization on a regular basis to confirm that AR metrics and benchmarks are consistently achieved. Originate and/or execute a portfolio of performance improvement projects for overall revenue cycle enhancement Conduct analysis as needed and on a timely basis, to support decisions by leadership and maintain/grow revenue collections. Assess direct reports' performance on a consistent basis and provide feedback to reward effective performance and enable proactive performance improvement steps to be taken. Originate and/or execute a portfolio of performance improvement projects for overall revenue cycle enhancement. Prepares reports and conducts analysis as needed and on a timely basis, to support decisions by leadership and maintain/grow revenue collection. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional healthcare related organizations Uses experience, education, training and judgment to plan and accomplish key performance indicators for AR metrics and other measures of organizational health. Educating, training and setting expectations on using the EHR system efficiently and effectively to meet industry key performance indicators. Maintains up-to-date payer knowledge including regular access to payer websites and portals to ensure the AR is flowing timely and appropriately. Performs additional special assignments, duties, and related functions as required. Works with Director of System PFS, Director PB Revenue Cycle, VP, CFO and vendor(s) to establish customer service / SBO revenue cycle benchmarks Reduce redundancies and re-work through proper use of technology and through staff education. Serves as the main point of contact for Patient AR Management including Client Submitter, and VNA AR. Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization's culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence. EDUCATION/EXPERIENCE/TRAINING: Bachelor's degree preferred or equivalent combination of education and 10 years experience. Minimum ten years health care with at least five years of healthcare Finance or Accounts Receivable Management experience. Prior experience with customer service and patient billing operations preferred. Home healthcare and hospice experience required. Minimum two years supervisory/management experience in healthcare environment required. Required three to five years of demonstrated experience with electronic health records. Epic experience preferred. Ability to work under pressure and manage multiple initiatives concurrently; must be able to work independently, set own priorities and meet deadlines. Experience and knowledge of regulatory requirements, payer requirements and third-party reimbursement. An understanding of complex corporate relationships, and an ability to influence within such an environment. Excellent communication, leadership, delegation, and interpersonal skills. Ability to evaluate personal performance against established goals. Ability to communicate with and present to a wide variety of CCHC and external users, including senior management and physicians, as well as outside vendors and consultants. Demonstrated goal-oriented thinking, operational and organizational skills. Ability to coach and support staff in their efforts to improve overall performance. Capable of learning reporting systems and other new tools Exceptional time management skills. Schedule Details: 32 hrs./week- Days-Monday-Friday Pay Range Details: The pay range displayed on each job posting reflects the anticipated range for new hires. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set, and education. This is not inclusive of the value of Cape Cod Healthcare's benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.

/RESPONSIBILITIES Provides technical and methodological design consultation, database development, data management, statistical analysis and results interpretation/reporting for a variety of internal and external projects including, but not limited to the Health System Medication Assistance Program (MAP) and 340B Drug Discount Program (340B Program) auditing and program compliance. Specific responsibilities include utilization of mainframe databases for the identification of appropriate study populations; data management, analysis planning and statistical analysis of data collected from data sources, patient surveys and claims data, ensuring timeliness and accuracy of data integration between the MAP and Pharmacy Department databases and managing 340B program internal audits. Develops complex reports from large, relational databases; and prepares policy statements and recommendations to assist UHS to improve the quality of patient services. Maintains the Cost Accounting System for MAP and reports cumulative expenditures and savings generated by the assistance program. EDUCATION/EXPERIENCE BS/BA degree in business or a related field is required. Related pharmacy and/or healthcare billing experience is required. Five years experience in a medical or pharmacology related field to include project coordination; database/spreadsheet development and management; and/or application programming; processing and overseeing medical insurance billing and reimbursement cost capture is preferred. Must have demonstrated appropriate independent judgment.

A bit about the Risk Adjustment Encounter Submissions team: The Risk Adjustment Encounter Submissions team is one of the 5 functional areas in Devoted's Risk Adjustment Department and is responsible for ensuring the timely and accurate submission of risk adjustment encounter data to CMS. Risk Adjustment Encounter Submissions work collaboratively with the other functional areas of the Risk Adjustment department, other departments across the organization, and external provider partners to continuously improve the accuracy of the data we submit to CMS. The Risk Adjustment Encounter Submissions team includes: Director of Encounter Submissions Encounter Submissions Manager Close partnership with Risk Adjustment focused data scientists and software engineers A bit about this role: The Risk Adjustment Encounter Submissions Manager supports the department by reviewing internally and externally sourced encounter data, identifying opportunities for improving day-to-day submissions operations and creating recommendations for implementation. This role also supports ongoing successful submissions of all ADDs and DELETEs to the Encounter Data Processing System (EDPS). Your Responsibilities and Impact will include: Review and monitor encounter data submissions for accuracy and completeness, identifying discrepancies and potential areas for improvement. Collaborate with cross-functional teams to implement and monitor corrective actions Develop and maintain documentation of submission processes, including troubleshooting and resolution strategies for data submission errors. Educate and train stakeholders on policies, procedures, and best practices related to encounter data submissions. Stay up-to-date on regulatory changes and industry best practices affecting risk adjustment and encounter data submissions. Required skills and experience: Bachelor's degree in healthcare, data analytics, or a related field; advanced degree preferred. Excellent communication and interpersonal skills, with a collaborative approach to problem-solving. Strong attention to detail and organizational skills to manage multiple priorities effectively. Ability to take initiative and drive projects forward in a fast-paced environment. Strong analytical skills with a proven ability to interpret complex data sets and identify key insights. Ability to establish and improve operational processes Desired skills and experience: Strong command of SQL; experience with Snowflake database Minimum of five years of substantive health care experience, operational experience or other consulting experience. #LI-Remote #LI-DS1 Salary Range: $76,000 - $126,000 per year The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and vision plan with low or no premium Generous paid time off $100 monthly mobile or internet stipend Stock options for all employees Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Healthcare equality is at the center of Devoted's mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we're on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That's why we're gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company - one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission! Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion. Primary Purpose The Patient Safety Clinical Risk Manager oversees patient safety and risk management across the health system, investigating safety events of all harm levels, conducting Cause Analyses, and addressing quality-of-care grievances. They support High Reliability Organization initiatives, participate in and/or lead safety improvement projects, and collaborate with clinical and operational leaders to enhance patient and workforce safety to improve quality outcomes. Minimum Specifications ONSITE Education Bachelor's degree in nursing, clinical, or healthcare-related field of study from an accredited college or university. Preferred Education: Master's degree in Nursing, Healthcare Risk Management, Patient Safety, Human Factors Engineering, Jurisprudence, Juris Doctor, or a related field of study from an accredited institution. Experience Five years of clinical or healthcare experience in an acute care setting. Two years of healthcare risk management and/or patient safety experience in an acute care facility is preferred. Equivalent Education and/or Experience A combination of education and experience in highly complex systems may substitute for years of required work experience. Certification/Registration/Licensure Nursing, clinical or other applicable license/certification is required and must be maintained throughout employment. Certification through a nationally recognized accreditation board in either Healthcare Risk Management (CPHRM) through American Society for Healthcare Risk Management (ASHRM) or Patient Safety (CPPS) through Institute for Healthcare Improvement (IHI) is preferred. Skills or Special Abilities Must be highly organized, self-motivated, and adaptable to high-pressure environments with the ability to pivot and change assignment focus based on needs. Must be able to excel at prioritizing tasks, working independently or in teams, and maintaining professionalism, confidentiality, and adherence to organizational standards. Must demonstrate strong analytical, investigative, and problem-solving skills. Must demonstrate good judgment and decision-making skills. Must be able to effectively collaborate with diverse stakeholders. Must consistently demonstrate commitment to Parkland Health ICARE Values and support Just Culture and High Reliability principles. Responsibilities Risk Management Conducts investigations into adverse events, safety posts, and Cause Analyses, ensuring timely escalation of significant issues. Leads investigations as defined by The Joint Commission's Sentinel Event policy, The National Quality Forum (NQF), Texas Department of State Health Services (TDSHS), and the Centers for Medicare and Medicaid Services (CMS) per regulatory standards. Maintains expertise in risk management systems and Enterprise Risk Management (ERM). Assists with disclosure conversations and provides real-time coaching for providers and staff as directed. Manages Quality-of-Care grievances, ensuring regulatory compliance and timely resolution. Investigates and reports Safe Medical Device Act (SMDA) incidents via reporting platforms, such as MedSun . Patient Safety Supports High Reliability and Just Culture initiatives to enhance patient safety and the psychological safety of those involved in safety events. Assesses, investigates, and trends safety posts, escalating concerns as needed. Builds strong relationships with stakeholders, providing education and routine data. Conducts regular rounds to engage frontline staff and reinforce shared learnings. Leads patient safety initiatives and contributes to program development. Ensures compliance with project deadlines and regulatory standards. Quality of Care Grievances Owns grievance investigations from inception to resolution, handling complex and sensitive cases. Drafts regulatory-compliant response letters. Ensures CMS compliance in grievance management. Utilizes complaint management systems to track and resolve grievances efficiently. Job Accountabilities Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding. Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.

Responsible for managing the Medicare Advantage risk adjustment process and encounter data processing (EDPS) in accordance with CMS regulations. The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the processes and systems that collect and process the data from claims, encounters, electronic medical records, medical record coding, and other supplemental data sources. This role acts as the risk adjustment program subject matter expert and works closely with other areas of health plan operations and programs, ensuring risk adjustment data operations are administered accurately, timely and in compliance with CMS regulations. ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. * Manage the Electronic Data Processing (EDPS) data submission process and ensure that all available data is accepted by CMS and manage the transition from RAPS to EDPS * Collaborates with coding staff & vendors to develop relevant coding guidance to the provider population consistent with established coding authorities and in compliance with relevant federal guidance * Establish and maintain HCC visit review program to ensure proper documentation of diagnoses, and validation of diagnoses with feedback to Providers * Responsible for responding to and overseeing CMS Risk Adjustment Data Validation (RADV), and OIG audit requests * Develop and update department's policies and procedures according to established workflows * Assist with the development, implementation, and oversight of auditing projects * Facilitate appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with providers, care management and nursing staff, other care givers and the coding staff * Review data and trends to identify additional areas of opportunity and to close gaps identified via data generated by Analytics * Deliver provider-specific metrics on Gap-closing opportunities as needed * Maintain knowledge of coding rules and program regulations to ensure the documentation in the patient record accurately reflects all elements impacting the patient risk score thereby contributing to a compliant patient record * Maintain vendor contracts and relationships as needed * Oversee vendor software users * Monitor vendor progress and performance and works to improve vendor performance if needed * Assist with developing coding policies and long-term plan to use technology and other resources to provide more and better information to network providers * Coordinate and develop metrics related to risk adjustment operations to inform leadership on progress of activities and risk adjustment programs * Maintain knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e. g., CMS) applicable to Risk Adjustment specifically and general knowledge of Medicare Advantage requirements to ensure that risk adjustment program is in compliance with government regulation * Draft and maintain policies and procedures, standard operating procedures, and work instructions * Develop resolution and plan for action for identified raps and EDPS discrepancies * Responsible for assisting leadership with implementation and oversight of risk adjustment and mechanism for projects * Other duties as assigned JOB REQUIREMENTS: * Excellent analytical and problem-solving skills * Ability to communicate to both internal and external clients on new developments * Enjoy engaging in the outlining of program development and management processes, manages the overall scoping, planning, business requirements gathering and delivery of risk adjustment program activities from idea inception to ongoing support and enhancement * Communicate with internal and external stakeholders - progress reporting and vendor management * Successful completion of required training * Handle multiple priorities effectively QUALIFICATIONS: * Bachelor's degree (or higher/equivalent) * Credentials preferred in any of the following: RHIA, RHIT, CCS and/or CPC, CRC, CCDS/CCDS-O, CDIP * Experience with risk adjustment data validations or equivalent compliance audits * Knowledge of RAPS, 837I and 837P EDPS formats and file protocols * Knowledge of CPT, ICD-9, ICD-10, HEDIS, Medicare services and reimbursement methodologies, RBRVS * Extensive knowledge of Medicare and CMS Risk Adjustment payment rules, regulations and guidelines as it relates to managed care organizations required * Ability to lead projects, initiatives, or teams as needed to achieve accurate & complete documentation for the health plan & health system clients * Relevant Coding/Auditing Experience, especially with some leadership experience in the area * Proven track record of managing partners / vendors * Background in analytics, statistics, data management * Ability to present effectively to clients & providers; strong ability to influence * A passion for results & a strong sense of ownership of the results

NATIONAL LEADERS IN PEDIATRIC CARE Ranked among the top 10 pediatric hospitals in the nation, Children's Hospital Los Angeles (CHLA) provides the best care for kids in California. Here world-class experts in medicine, education and research work together to deliver family-centered care half a million times each year. From primary to complex critical care, more than 350 programs and services are offered, each one specially designed for children. The CHLA of the future is brighter than can be imagined. Investments in technology, research and innovation will create care that is personal, convenient and empowering. Our scientists will work with clinical experts to take laboratory discoveries and create treatments that are a perfect match for every patient. And together, CHLA team members will turn health care into health transformation. Join a hospital where the work you do will matter-to you, to your colleagues, and above all, to our patients and families. The work will be challenging, but always rewarding. It's Work That Matters. Overview This position is 100% onsite. Purpose Statement/Position Summary: Responsible for supporting the creation and direction of the risk management programs for CHLA. Will assist with leading initiatives that align with the organization's strategic goals to maximize the protection of the operational assets. Has the responsibility to create, implement and enforce risk tolerance policies for CHLA and provide the organization with education and direction for all areas of potential risk. Work collaboratively with CHLAMG related to shared risk and claims management. Minimum Qualifications/Work Experience: Required: 5+ years' risk management, claims, professional liability and/or clinical experience including 2+ years of Director, Risk Management experience. Or, 7+ years' risk management, claims, professional liability and/or clinical experience. Preferred: Management/leadership experience. Education/Licensure/Certification: Required: Bachelor's degree or equivalent combination of related education and work experience. Preferred: JD or RN. Pay Scale Information USD $169,042 - USD $289,786 CHLA values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on a number of factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this specific job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs. CHLA looks forward to introducing you to our world-class organization where we create hope and build healthier futures. Children's Hospital Los Angeles (CHLA) is a leader in pediatric and adolescent health both here and across the globe. As a premier Magnet teaching hospital, you'll find an environment that's alive with learning, rooted in care and compassion, and home to thought leadership and unwavering support. CHLA is dedicated to creating hope and building healthier futures - for our patients, as well as for you and your career! CHLA has been affiliated with the Keck School of Medicine of the University of Southern California since 1932. At Children's Hospital Los Angeles, our work matters. And so do each and every one of our valued team members. CHLA is an Equal Employment Opportunity employer. We consider qualified applicants for all positions without regard to race, color, religion, creed, national origin, sex, gender identity, age, physical or mental disability, sexual orientation, marital status, veteran or military status, genetic information or any other legally protected basis under federal, state or local laws, regulations or ordinances. We will also consider for employment qualified applicants with criminal history, in a manner consistent with the requirements of state and local laws, including the LA City Fair Chance Ordinance and SF Fair Chance Ordinance. Qualified Applicants with disabilities are entitled to reasonable accommodation under the California Fair Employment and Housing Act and the Americans with Disabilities Act. Please contact CHLA Human Resources if you need assistance completing the application process. Our various experiences, perspectives and backgrounds allow us to better serve our patients and create a strong community at CHLA. Legal Affairs Risk Management

Primary Accountability The Director of Quality Improvement & Risk Management is responsible for the development, implementation and monitoring of quality improvement and assurance programs and programs that identify safety and security risks associated with the environment of care for Family HealthCare Network in such a way that promotes the highest level of quality and safety in the services provided in the organization. Description of Primary Responsibilities Provide overall management and direction to departmental/division staff. Responsible for performance management of departmental employees, including all managers, supervisors, and employees in the department, including recognition, performance evaluations, formal coaching and counseling, and making decisions or recommendations regarding necessary disciplinary actions. Responsible for recommending hiring or firing and the advancement and promotion of managers, supervisors, and employees in the department, or any other change status of manager, supervisors, and employees in the department. Demonstrates core leadership behaviors and team one approach. Demonstrates a high level of emotional intelligence. Creates a culture of accountability and excellence. Drives execution and innovation. Ensures division alignment with organizational culture and strategic vision. Ensures the development and successful execution of an action plan across the assigned employee base to support the organization's strategic direction and the achievement of operational goals for assigned departments/divisions, effectively leading change when necessary. Empower staff through effective communication and talent development. Ensures team members of all assigned areas of responsibility are fully functional and performing at a world-class level. Ensures development of department/division managers and supervisors receive instruction/training that is in compliance with a training plan, including on-the-job training to develop department employees. Works with manager and/or supervisor to ensure necessary remediation is taken with department/division employees assigned. Assists with developing assigned departmental/division budget(s) and monitors the budget to ensure expenses do not exceed the budget. Ensures regulatory compliance for assigned departments/divisions and compliance with all workflows, policies, and procedures. Recommends workflow, policy, and procedure changes based on observations from performance metrics, outcomes, and feedback from assigned leadership team members. Ensures department maintains compliance with all employees related reporting and tracking. Responsible for overseeing the quality improvement, risk management, patient safety, patient satisfaction survey, emergency preparedness, injury and illness prevention, and infection control programs for the Network. Ensures relevant policies are in compliance with regulatory and accrediting bodies. Ensures reporting tracking and monitoring mechanisms are in place to ensure ongoing compliance. Reports regularly to the appropriate committees for ongoing quality improvement and risk mitigation. Provide expertise related to quality improvement and risk management. Serves as a liaison and quality education resource for other departments. Serves as or designates a delegate on both standing and ad hoc committees whose activities related to quality improvement. Maintains working knowledge to ensure compliance of and administratively support QI team on subject matter related to QI/QA activities, including but not limited to: Health Resources and Services Administration (HRSA) regulation; The Joint Commission Standards; National Committee for Quality Assurance (NCQA) Patient-Centered Health Home certification requirements; Meaningful Use requirements and reporting; Federal Tort Claims Act (FTCA) coverage and other risk mitigation topics; Emergency preparedness, and OSHA, Title 22, and other regulatory entities. Assists in the creation and review of QI and risk management policies and procedures annually. Responsible for ensuring the organization meets accreditation and regulatory standards, fulfills federal and state reporting requirements and provides the highest quality care in a safe, timely, and patient-centered manner. Responsible for FHCN policy and procedures manual and ensures an annual review. Coordinates the development of, reviews, updates, and oversees the implementation of survey systems, audit tools, and programs that gather data and provide necessary quality-related information to Health Center staff and other teams. Examples include, but are not limited to: Quality of clinical performance measures; Operational efficiency measures; Effectiveness of continuity of care; Hazard and Safety audits; and Tracking and analysis of risk events and their mitigation. Responsible for maintaining insurance affairs for FHCN. Ensures application, maintenance/renewal, and compliance with general liability, auto, property, and malpractice insurance coverage, including FTCA and gap insurance programs. Ensures implementation and adherence to risk plans. Ensures compliance with transportation fleet registration and certification of personnel employment eligibility. Performs other duties as assigned. Description of Primary Attributes Professional & Technical Knowledge: Possesses specific advanced knowledge skills, including written and verbal communication skills, computational, computer, and technical skills, and mathematical knowledge acquired through the completion of a bachelor's degree program with a recognized major or a comparable level of business/industry acumen. Performance of the job's duties and responsibilities requires the equivalent of formal training in quality improvement analytics, usually in the form of a major involving health care or other analytics or as part of a bachelor's degree program. Minimum of six (6) years of leadership experience or seven (7) years of progressively greater responsibility, including significant contributions to projects and initiatives that demonstrate leadership skills. Knowledge of regulatory requirements, including HIPAA, Title 22, CDPH, and OSHA, and accreditation processes of the Joint Commission preferred. Technical Skills: Ability to create highly complex documents in Microsoft Word, including linking multiple files and embedding objects linked to other documents. Ability to use advanced functions of Microsoft Excel, such as creating and managing databases, including creating standardized reports or linking multiple worksheets and workbooks. Ability to develop sophisticated presentations in Microsoft PowerPoint, including embedded objects, transitions, and other elements. Licenses & Certifications: Risk Management certification must be completed within the first year of employment through organizations such as the American Society for Healthcare Risk Management (ASHRM), California Primary Care Association (CPCA), or certification from another accredited agency may be considered. Communications Skills: Job duties require the employee to effectively communicate, verbally and in writing, their opinions and extrapolations of information they collect and synthesize/analyze. Responsible for resolving conflicts arising from disagreements between employees, between employees and customers/clients, or with the public, other legal entities, or governmental authorities. Compiles, analyzes and prepares information in effective written form, including correspondence, reports, articles, or other documentation. Effectively conveys technical information to non-technical audiences. Physical Demands: The physical demands described in this job description are representative of those that an employee must meet to successfully perform the essential functions of this position. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this position, the employee is regularly required to sit and use repetitive hand movements to type and grasp. The employee is frequently required to stand or walk and must occasionally lift and/or move up to 20 pounds. Pay Scale: Min Salary Rate: $111,597.05 Max Salary Rate: $178,555.28

Primary Accountability The Director of Quality Improvement & Risk Management is responsible for the development, implementation and monitoring of quality improvement and assurance programs and programs that identify safety and security risks associated with the environment of care for Family HealthCare Network in such a way that promotes the highest level of quality and safety in the services provided in the organization. Description of Primary Responsibilities * Provide overall management and direction to departmental/division staff. * Responsible for performance management of departmental employees, including all managers, supervisors, and employees in the department, including recognition, performance evaluations, formal coaching and counseling, and making decisions or recommendations regarding necessary disciplinary actions. * Responsible for recommending hiring or firing and the advancement and promotion of managers, supervisors, and employees in the department, or any other change status of manager, supervisors, and employees in the department. * Demonstrates core leadership behaviors and team one approach. * Demonstrates a high level of emotional intelligence. * Creates a culture of accountability and excellence. * Drives execution and innovation. * Ensures division alignment with organizational culture and strategic vision. * Ensures the development and successful execution of an action plan across the assigned employee base to support the organization's strategic direction and the achievement of operational goals for assigned departments/divisions, effectively leading change when necessary. * Empower staff through effective communication and talent development. * Ensures team members of all assigned areas of responsibility are fully functional and performing at a world-class level. * Ensures development of department/division managers and supervisors receive instruction/training that is in compliance with a training plan, including on-the-job training to develop department employees. Works with manager and/or supervisor to ensure necessary remediation is taken with department/division employees assigned. * Assists with developing assigned departmental/division budget(s) and monitors the budget to ensure expenses do not exceed the budget. * Ensures regulatory compliance for assigned departments/divisions and compliance with all workflows, policies, and procedures. * Recommends workflow, policy, and procedure changes based on observations from performance metrics, outcomes, and feedback from assigned leadership team members. * Ensures department maintains compliance with all employees related reporting and tracking. * Responsible for overseeing the quality improvement, risk management, patient safety, patient satisfaction survey, emergency preparedness, injury and illness prevention, and infection control programs for the Network. * Ensures relevant policies are in compliance with regulatory and accrediting bodies. * Ensures reporting tracking and monitoring mechanisms are in place to ensure ongoing compliance. * Reports regularly to the appropriate committees for ongoing quality improvement and risk mitigation. * Provide expertise related to quality improvement and risk management. * Serves as a liaison and quality education resource for other departments. * Serves as or designates a delegate on both standing and ad hoc committees whose * activities related to quality improvement. * Maintains working knowledge to ensure compliance of and administratively support QI team on subject matter related to QI/QA activities, including but not limited to: * Health Resources and Services Administration (HRSA) regulation; * The Joint Commission Standards; * National Committee for Quality Assurance (NCQA) Patient-Centered Health Home certification requirements; * Meaningful Use requirements and reporting; * Federal Tort Claims Act (FTCA) coverage and other risk mitigation topics; * Emergency preparedness, and * OSHA, Title 22, and other regulatory entities. * Assists in the creation and review of QI and risk management policies and procedures annually. * Responsible for ensuring the organization meets accreditation and regulatory standards, fulfills federal and state reporting requirements and provides the highest quality care in a safe, timely, and patient-centered manner. * Responsible for FHCN policy and procedures manual and ensures an annual review. * Coordinates the development of, reviews, updates, and oversees the implementation of survey systems, audit tools, and programs that gather data and provide necessary quality-related information to Health Center staff and other teams. Examples include, but are not limited to: * Quality of clinical performance measures; * Operational efficiency measures; * Effectiveness of continuity of care; * Hazard and Safety audits; and * Tracking and analysis of risk events and their mitigation. * Responsible for maintaining insurance affairs for FHCN. * Ensures application, maintenance/renewal, and compliance with general liability, auto, property, and malpractice insurance coverage, including FTCA and gap insurance programs. * Ensures implementation and adherence to risk plans. * Ensures compliance with transportation fleet registration and certification of personnel employment eligibility. * Performs other duties as assigned. Description of Primary Attributes Professional & Technical Knowledge: * Possesses specific advanced knowledge skills, including written and verbal communication skills, computational, computer, and technical skills, and mathematical knowledge acquired through the completion of a bachelor's degree program with a recognized major or a comparable level of business/industry acumen. * Performance of the job's duties and responsibilities requires the equivalent of formal training in quality improvement analytics, usually in the form of a major involving health care or other analytics or as part of a bachelor's degree program. * Minimum of six (6) years of leadership experience or seven (7) years of progressively greater responsibility, including significant contributions to projects and initiatives that demonstrate leadership skills. * Knowledge of regulatory requirements, including HIPAA, Title 22, CDPH, and OSHA, and accreditation processes of the Joint Commission preferred. Technical Skills: * Ability to create highly complex documents in Microsoft Word, including linking multiple files and embedding objects linked to other documents. * Ability to use advanced functions of Microsoft Excel, such as creating and managing databases, including creating standardized reports or linking multiple worksheets and workbooks. * Ability to develop sophisticated presentations in Microsoft PowerPoint, including embedded objects, transitions, and other elements. Licenses & Certifications: Risk Management certification must be completed within the first year of employment through organizations such as the American Society for Healthcare Risk Management (ASHRM), California Primary Care Association (CPCA), or certification from another accredited agency may be considered. Communications Skills: * Job duties require the employee to effectively communicate, verbally and in writing, their opinions and extrapolations of information they collect and synthesize/analyze. * Responsible for resolving conflicts arising from disagreements between employees, between employees and customers/clients, or with the public, other legal entities, or governmental authorities. * Compiles, analyzes and prepares information in effective written form, including correspondence, reports, articles, or other documentation. * Effectively conveys technical information to non-technical audiences. Physical Demands: The physical demands described in this job description are representative of those that an employee must meet to successfully perform the essential functions of this position. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this position, the employee is regularly required to sit and use repetitive hand movements to type and grasp. The employee is frequently required to stand or walk and must occasionally lift and/or move up to 20 pounds. Pay Scale: Min Salary Rate: $111,597.05 Max Salary Rate: $178,555.28

Responsible for the coordination of the clinical risk management program in hospital and/or clinic affiliate entities. Collects and analyzes variance data, assesses potentially dangerous and unsafe events, promotes quality assurance activities and educates staff and managers on good risk management principles and their value in reducing overall liability for the organization. 1. Risk Reduction * Develops programs for risk recognition, investigation, and reduction. * Manages incident reporting system and ensures timely follow up and investigation. 2. Documentation * Timely documentation and reporting. * Prepares accurate and comprehensive reports. * Prepares statistical reports of events for presentation to managers and sr. management teams. 3. Consultation and Partnerships * Manage on or more any of the following in accordance with hospital policy: Product Recall, Auto, Property, Security, Emergency Preparedness. * Manages on or more any of the following in accordance with hospital policy: Product Recall, Auto, Property, Security, Emergency Preparedness. * Presents educational programs for hospital personnel in an effort to reduce liability in the organization. 4. Claims Management * Manages claims in accordance with system policies. Sets accurate reserves. * Reports all potentials and lawsuits to appropriate insurance carriers in timely manner. * Works with attorneys to prepare documents for litigation. Works with employees to prepare them for litigation. * Reviews patient complaints that may have potential for litigation and negotiates fair settlements if prudent.. * 3 years risk mgmt in health care, claims, or legal case review preferred * RN graduate or BS in business * Ability to evaluate data. Excellent interpersonal skills * if RN must maintain current License

Southwest Care Center employees can answer yes to these 3 questions: 1. Do you want to make a difference? 2. Do you believe everyone is entitled to quality healthcare? 3. Do you desire to serve the underserved in your community? For over 25 years, Southwest Care Center has been providing exceptional healthcare to the communities of Santa Fe and Albuquerque, NM. We are a non-profit, FQHC-LAL providing medical, behavioral health, case management, community outreach, diabetes education, and pharmacy services. We are proud to offer gender equity medicine, syringe exchange, and HIV/Hep C treatment, testing and other services within our communities. Southwest Care Center is currently seeking an experienced full-time Compliance & Risk Manager. This position supports clinics in both Santa Fe and Albuquerque, NM requiring the candidate to reside in the local area. Position Details: Reporting to the Director of Clinical & Quality Outcomes, the Compliance & Risk Manager with dotted line reporting to the CEO for compliance, the Compliance and Risk Manager is responsible for developing, implementing, and overseeing an effective Compliance and Risk Management Program for the organization. This role ensures adherence to federal, state, and local regulatory requirements, maintains organizational policies and procedures consistent with FQHC standards, and promotes a culture of ethical conduct, patient safety, and continuous improvement. The Compliance & Risk Manager works collaboratively with leadership, clinical teams, and operational departments to proactively identify, mitigate, and monitor organizational risks. Position responsibilities include but not limited to: Compliance Program Oversight • Maintain and enhance the organization's Compliance Program in alignment with HRSA, CMS, OIG, HIPAA, and UDS requirements. • Ensure policies and procedures are accurate, current, and compliant with all regulatory standards. • Conduct regular audits, monitoring activities, and internal reviews to identify areas of non-compliance. • Lead and coordinate the annual Compliance Work Plan. • Manage compliance investigations, incident reviews, and corrective action plans. • Oversee the anonymous reporting hotline and ensure proper follow-up and documentation of concerns. Risk Management • Lead the development and implementation of the organization's Risk Management Plan. • Conduct enterprise risk assessments, identify emerging risks, and recommend mitigation strategies. • Monitor incident reports, patient safety events, and trends to reduce organizational risk. • Collaborate with clinical leadership to enhance patient safety and quality improvement initiatives. • Serve as the primary liaison for malpractice, liability, or incident-related claims. Survey Readiness • Ensure organizational readiness for HRSA operational site visits (OSV), accreditation surveys, and external audits. • Coordinate collection of documentation, corrective actions, and regulatory reporting. • Monitor changes in federal and state regulations and communicate impacts to leadership. • Responsible for maintaining the Compliatric portal in a manner that ensure regulatory compliance and data can be effectively and accurately extracted as needed for audit compliance and use by organization. HIPAA Privacy & Security • Serve as the organization's HIPAA Privacy Officer. • Develop, implement, and monitor HIPAA policies related to privacy, confidentiality, and security. • Conduct breach investigations, risk assessments, and required notifications. • Oversee workforce privacy and cybersecurity awareness training. Education & Training • Facilitate ongoing compliance, risk, HIPAA, and ethics training for all staff. • Educate leadership and employees on regulatory updates and best practices. • Develop training materials, tools, and resources to support compliance across departments. Reporting & Documentation • Prepare compliance and risk reports for the CEO, Senior Leadership Team, and Board Compliance Committee. • Maintain complete and accurate compliance and risk management documentation. • Track and report key performance indicators related to program effectiveness. • Represent the areas of compliance and risk at organizational committees and workgroups. Other Duties as Assigned Candidate Highlights: Required Qualifications: • Bachelor's degree in business, healthcare, or related field. • Three (3) years in a role with primary function focused on compliance and risk in a healthcare setting. • Two (2) years of supervisory managing a compliance and risk program within a healthcare setting. • Knowledge of FQHC programs, Ryan White, HOPWA, and other grant funded programs. • Experience working with diverse populations, including LGBTQ+ communities, persons with HIV, and individuals experiencing homelessness. • Strong understanding of confidentiality laws (HIPAA/42 CFR Part 2). • Valid NM driver's license and ability to travel to outreach sites and all clinics within the organization. Preferred Qualifications: • Master's degree in business, healthcare, or related field • Experience in FQHC or community health settings. • Familiarity with CAREWare, HMIS, and EHR systems. • Bilingual (English/Spanish or English/Navajo) Employment Highlights: Monday - Friday typical schedule. Competitive salary. Great work/life balance with generous time off plans. Full benefits package includes medical, dental, vision, 401k with substantial employer contribution, paid time off, professional development programs, and 340B prescription access. Interested in this Position? Need More Information? Apply today and we will connect you with a member of our recruitment team. We look forward to speaking with you soon. If you experience difficulty applying or need assistance please contact ********************. *Please note, we are unable to respond to resume inquiries. Living & Working in New Mexico: The Land of Enchantment offers residents a way of life that you won't find anywhere else in the United States. Our clinic locations are in Santa Fe and Albuquerque, NM. Each with its own unique vibe and both offering all the perks you get when you call New Mexico Home. Rich cultural and historical diversity. 310 days of sunshine, combined with a mild, dry climate and four distinct seasons! You'll forget what humidity is when you live here. Unlimited year-round outdoor opportunities including hiking, rock-climbing, rafting, motorized sports, and even skiing. Yes, we have really big ski mountains in and around the deserts of New Mexico! Diverse and inclusive communities with amazingly kind people from all walks of life. Gorgeous landscapes that include desert and majestic mountains. New Mexico has to be to be seen to believe. Continuous festivals, concerts, and events including the internationally known Balloon Fiesta of Albuquerque. International airport providing low-cost, quick access in-country and out. Big city amenities found in Albuquerque with easy access from Santa Fe (50 min). Many of our employees commute between these cities. Both cities are connected by the NM rail system for those looking for a relaxing commute with a breath-taking view. Great schools and family friendly communities. And let's not forget about New Mexican cuisine-it is some of the best food in the country. Will you have red or green? Southwest Care Center is an equal opportunity employer. We offer equal employment opportunities to employees and applicants without regard to race, color, religion, sex, age, national origin, disability status, protected veteran status, sexual orientation, gender identity, or any other characteristic protected by federal or state law. Job Details: Location:NM Santa Fe - Admin GalisteoWorker Type:EmployeeRegularScheduled Weekly Hours:40

Full-time Description The Patient Safety Coordinator supports the identification, documentation, investigation, and follow-up of patient safety events across all organ, tissue, and eye donation operations. This position assists with communication and coordination between the Organ Procurement Organization (OPO), the Organ Procurement and Transplantation Network (OPTN), Health Resources and Services Administration (HRSA), donor hospitals, transplant centers, and patient families regarding safety-related concerns. The Patient Safety Coordinator promotes a culture of transparency and accountability by facilitating timely reporting, supporting investigations, and assisting with the implementation of safety improvements to enhance patient and donor safety. ESSENTIAL FUNCTIONS Essential Functions Statement(s) Assist in monitoring and investigating reported or suspected patient safety events, near misses, and adverse outcomes in real time. Support 24/7/365 coverage of patient safety functions through coordination with clinical and administrative teams. Serve as a key point of contact for patients, donor families, hospital partners, transplant centers, the OPTN, and HRSA regarding safety concerns, complaints, and potential donor-derived disease events. Document and submit safety incidents, complaints, near misses, and adverse events to the OPTN and internal databases in accordance with regulatory requirements. Track, trend, and analyze safety-related occurrences to identify patterns and opportunities for process improvement. Participate in and provide administrative support for root cause analyses (RCA), including gathering data, organizing documentation, and assisting in development of corrective actions. Collaborate with internal departments to ensure updates to OPTN patient safety policies are incorporated into NDN policies, procedures, and training materials. Assist in monitoring the implementation and effectiveness of corrective and preventive actions. Coordinate with internal and external stakeholders to ensure safety processes are consistently applied across clinical and operational workflows. Assist with the development and delivery of education and training programs related to patient safety, event reporting, and RCA processes. Support a culture of patient and donor safety through communication, data integrity, and process improvement initiatives. Perform other duties as assigned. Requirements POSITION QUALIFICATIONS Competency Statement(s) - Position Specific · Accuracy - Ability to perform work accurately and thoroughly. · Analytical Skills - Ability to use thinking and reasoning to solve a problem. · Autonomy - Ability to work independently with minimal supervision. · Coaching and Development - Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas. · Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards. · Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions. · Management Skills - Ability to organize and direct oneself and effectively supervise others. · Problem Solving - Ability to find a solution for or to deal proactively with work-related problems. · Technical Aptitude - Ability to comprehend complex technical topics and specialized information. · Tolerance - Ability to work successfully with a variety of people without making judgments. Competency Statement(s) - Company Specific Understand and commit to the following: Organizational Core Purpose: To save and heal lives. Core Values: Relentless, Joyful, Selfless. Strategic Anchors: Mutually beneficial partnerships, diverse revenue streams and get to yes: every donor every time · Accountability - Ability to accept responsibility and account for his/her actions. · Adaptability - Ability to adapt to change in the workplace. · Communication, Oral - Ability to communicate effectively with others using the spoken word. · Communication, Written - Ability to communicate in writing clearly and concisely. · Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type. · Judgment - The ability to formulate a sound decision using the available information. · Team Builder - Ability to convince a group of people to work toward a goal. · Compliance - Ability of the individual to be in accordance with established guidelines, policy, standards or legislation. SKILLS & ABILITIES Education: Bachelor's Degree in business or healthcare field; Master's Degree preferred; years of experience may be considered in lieu of education. Experience: Two to four years related experience in organ/tissue/ocular donation or healthcare related field and in supervision or management of others Computer Skills: Knowledge of MS office programs Certificates & Licenses: Six Sigma Black Belt, but not required. ASQ required Other Requirements: None NDN has reviewed this to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and NDN reserves the right to change this job description and/or assign tasks for the employee to perform, as NDN may deem appropriate.

Responsible for managing the Medicare Advantage risk adjustment process and encounter data processing (EDPS) in accordance with CMS regulations. The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the processes and systems that collect and process the data from claims, encounters, electronic medical records, medical record coding, and other supplemental data sources. This role acts as the risk adjustment program subject matter expert and works closely with other areas of health plan operations and programs, ensuring risk adjustment data operations are administered accurately, timely and in compliance with CMS regulations. ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. * Manage the Electronic Data Processing (EDPS) data submission process and ensure that all available data is accepted by CMS and manage the transition from RAPS to EDPS * Collaborates with coding staff & vendors to develop relevant coding guidance to the provider population consistent with established coding authorities and in compliance with relevant federal guidance * Establish and maintain HCC visit review program to ensure proper documentation of diagnoses, and validation of diagnoses with feedback to Providers * Responsible for responding to and overseeing CMS Risk Adjustment Data Validation (RADV), and OIG audit requests * Develop and update department's policies and procedures according to established workflows * Assist with the development, implementation, and oversight of auditing projects * Facilitate appropriate modifications to clinical documentation to accurately reflect patient severity of illness and risk through extensive interaction with providers, care management and nursing staff, other care givers and the coding staff * Review data and trends to identify additional areas of opportunity and to close gaps identified via data generated by Analytics * Deliver provider-specific metrics on Gap-closing opportunities as needed * Maintain knowledge of coding rules and program regulations to ensure the documentation in the patient record accurately reflects all elements impacting the patient risk score thereby contributing to a compliant patient record * Maintain vendor contracts and relationships as needed * Oversee vendor software users * Monitor vendor progress and performance and works to improve vendor performance if needed * Assist with developing coding policies and long-term plan to use technology and other resources to provide more and better information to network providers * Coordinate and develop metrics related to risk adjustment operations to inform leadership on progress of activities and risk adjustment programs * Maintain knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e. g., CMS) applicable to Risk Adjustment specifically and general knowledge of Medicare Advantage requirements to ensure that risk adjustment program is in compliance with government regulation * Draft and maintain policies and procedures, standard operating procedures, and work instructions * Develop resolution and plan for action for identified raps and EDPS discrepancies * Responsible for assisting leadership with implementation and oversight of risk adjustment and mechanism for projects * Other duties as assigned JOB REQUIREMENTS: * Excellent analytical and problem-solving skills * Ability to communicate to both internal and external clients on new developments * Enjoy engaging in the outlining of program development and management processes, manages the overall scoping, planning, business requirements gathering and delivery of risk adjustment program activities from idea inception to ongoing support and enhancement * Communicate with internal and external stakeholders - progress reporting and vendor management * Successful completion of required training * Handle multiple priorities effectively QUALIFICATIONS: * Bachelor's degree (or higher/equivalent) * Credentials preferred in any of the following: RHIA, RHIT, CCS and/or CPC, CRC, CCDS/CCDS-O, CDIP * Experience with risk adjustment data validations or equivalent compliance audits * Knowledge of RAPS, 837I and 837P EDPS formats and file protocols * Knowledge of CPT, ICD-9, ICD-10, HEDIS, Medicare services and reimbursement methodologies, RBRVS * Extensive knowledge of Medicare and CMS Risk Adjustment payment rules, regulations and guidelines as it relates to managed care organizations required * Ability to lead projects, initiatives, or teams as needed to achieve accurate & complete documentation for the health plan & health system clients * Relevant Coding/Auditing Experience, especially with some leadership experience in the area * Proven track record of managing partners / vendors * Background in analytics, statistics, data management * Ability to present effectively to clients & providers; strong ability to influence * A passion for results & a strong sense of ownership of the results

This position is responsible for identifying risks, assessing how serious or severe the risks are and determining ways to minimize or eliminate the impact of negative events while avoiding harm and related financial losses to the organization. In addition, this position helps to sustain safety in the workplace and minimizes the exposure to health and safety hazards. The Risk & Safety Manager focuses on those events or occurrences that may cause injury or harm to our patients and the company's employees, assets, and reputation. KEY RESPONSIBILITIES Track, Identify, and analyze all safety and health incidents in order to identify high risks areas and procedures and to assist the company in the implementation of appropriate education and training processes to decrease incidents and to increase safety. Responsible for maintaining a safe work environment to include: safety inspections, quarterly safety committee meetings, data driven education and changes, and quarterly safety education. Maintains all regulatory compliance related to safety and risk management issues, including but not limited to MSDS maintenance and OSHA reporting Responsible for incident investigations, reporting and management of claims file. Responsible for the management of the workers compensation program Monitors employee driving records and insurability. Oversees pre-employment physicals, drug screenings and criminal background checks. Manages the continuation of professional insurance coverage ensures through follow-up to all legal claims made by or against the organization and its representatives. Responsible for ensuring that assigned departments are in compliance with all local, state, and federal laws (i.e. Pinellas County, ambulance service agreement, state and county regulations, HIPAA and OSHA). Performs all other duties as assigned. POSITION QUALIFICATIONS Bachelor's degree in a related field from an accredited four-year college or university or equivalent risk management experience Knowledge of OSHA regulations Knowledge of insurance regulations and claims processing Computer Skills and Microsoft Office Knowledge WORKING ENVIRONMENT Professional office environment Occasional travel PHYSICAL REQUIREMENTS Occasionally: Walking inside, carrying no greater than 25 pounds, kneeling, stooping, bending, leaning Frequently: Hearing/listening, clear speech, touching, typing Constantly: Sitting, seeing Must be able to perform the essential duties of the position with or without reasonable accommodations

SUMMARY/JOB PURPOSE: The PVRM Medical Director is responsible for the medical review of Individual Case Safety Reports (ICSRs) for Exelixis products and is involved with other safety deliverables (eg safety surveillance) for assigned project(s). The role collaborates closely with Drug Safety Operations staff (on medical aspects of ICSRs) and Clinical Development (medical ICSR discussion and follow-up, as well as safety surveillance). The role supports regulatory compliance with pharmacovigilance regulations, safety signal detection/management, and contributes to the overall benefit-risk management of Exelixis products. Essential Duties And Responsibilities: This role operates in a matrix environment within the drug safety function and cross-functionally with other departments. Responsibilities for this position include: * Perform medical review of ICSRs for assigned product(s) in clinical development or for marketed products * Ensure that ICSRs contain accurate medical content through appropriate querying and obtained source data verification. * Collaborate closely with Drug Safety staff providing medical expertise and guidance for proper gathering, evaluation, medical assessment, and follow-up of ICSRs. * Review and/or Author an Analysis of Similar Events (ASE) for expedited cases. * Identify clinically important cases and lead the discussion on such cases by liaising with the medical monitor of the respective clinical study to discuss next steps. * Review global literature for assigned products for identification of ICSRs and assess their reportability. * Contribute to aggregate safety data reviews, signal evaluation, interpretation and documentation for assigned project(s) or product(s) * Provide medical input in the development and maintenance of RMPs for assigned product(s) * Contribute to science sections of the aggregate reports for assigned product(s) * Provide medical input for the Reference Safety Information (RSI) for assigned product(s) * Contribute/lead, participate and support Benefit-Risk Team meetings for assigned project(s) and product(s) * Provide safety input in study protocols, study reports or high-level summary documents for regulatory filings for assigned project(s) or product(s) * Prepare and present safety data for Data Monitoring Committees for specified project(s) or product(s) Supervisory Responsibilities: * No supervisory responsibilities. EDUCATION/EXPERIENCE/KNOWLEDGE & SKILLS: Education/Experience: * M.D. degree required and a minimum of 5 years of experience post-residency with at least 2+ years of clinical experience post-residency; or, * Equivalent combination of education and experience. * Completion of an accredited medical or surgical residency program is required. Board certification is preferred. Experience/The Ideal for Successful Entry into Job: * High level of medical competence with an ability to balance this with industry standards. * A minimum of 5+ years of experience in a medical review role in the pharmaceutical industry with a strong understanding of relevant regulatory requirements. * Prior experience in Oncology is preferred. * Significant clinical experience (~ 5 years) may compensate for shorter experience in a pharmaceutical/biotech company Knowledge/Skills: * Extensive knowledge of biotechnology/pharmaceutical sector drivers and practices * Demonstrated and excellent knowledge of relevant international regulations, guidance and initiatives governing both clinical trial and post-marketing safety environments * Demonstrates advanced skill and keen insight in gathering, sorting and applying key information to solve problems * Demonstrates good organizational and planning skills by managing time, workload and resources of a team * Leads and manages a team to execute on team objectives that contribute to accomplishing common functional and departmental goals * Demonstrates clear and effective verbal and written communication. Provides timely and appropriate information updates. Speaks clearly and confidently in one-to-one situations and effectively presents information to cross-functional groups of team members and colleagues. * Fosters collaboration among team members. Encourages teams to align on common goals. Engages internal and external stakeholders to build relationships. * Good interpersonal skills and demonstrable ability to bring differing views to develop an agreed upon resolution * Develops procedures, tasks and tools. Trains staff on departmental products, tools and data sources. Develops and maintains knowledge of cross-functional products, tools and data sources. Mentors junior team members. JOB COMPLEXITY: * Capable of proactively assessing workload, trends, tasks and priorities for area of responsibility * Plans and executes multiple activities * Considers alternative methods and contingency plans to avoid potential issues * Designs and implements solutions to address project level challenges, taking into consideration the broader impact Working Conditions: Notice to Recruiters/Staffing Agencies Recruiters and staffing agencies should not contact Exelixis, Inc. through this page. We require that all recruiters and staffing agencies have a signed contract on file and be assigned a specific search by our human resources department. Any resumes submitted through the website or directly by recruiters or staffing agencies that do not meet the above-mentioned criteria will be considered unsolicited and the company will not be responsible for any related fees. #LI-MB1 If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us! Our compensation reflects the cost of labor across several U.S. geographic markets, and we pay differently based on those defined markets. The base pay range for this position is $226,000 - $321,500 annually. The base pay range may take into account the candidate's geographic region, which will adjust the pay depending on the specific work location. The base pay offered will take into account the candidate's geographic region, job-related knowledge, skills, experience and internal equity, among other factors. In addition to the base salary, as part of our Total Rewards program, Exelixis offers comprehensive employee benefits package, including a 401k plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts. Employees are also eligible for a discretionary annual bonus program, or if field sales staff, a sales-based incentive plan. Exelixis also offers employees the opportunity to purchase company stock, and receive long-term incentives, 15 accrued vacation days in their first year, 17 paid holidays including a company-wide winter shutdown in December, and up to 10 sick days throughout the calendar year. DISCLAIMER The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

SUMMARY/JOB PURPOSE: The PVRM Medical Director is responsible for the medical review of Individual Case Safety Reports (ICSRs) for Exelixis products and is involved with other safety deliverables (eg safety surveillance) for assigned project(s). The role collaborates closely with Drug Safety Operations staff (on medical aspects of ICSRs) and Clinical Development (medical ICSR discussion and follow-up, as well as safety surveillance). The role supports regulatory compliance with pharmacovigilance regulations, safety signal detection/management, and contributes to the overall benefit-risk management of Exelixis products. Essential Duties And Responsibilities: This role operates in a matrix environment within the drug safety function and cross-functionally with other departments. Responsibilities for this position include: Perform medical review of ICSRs for assigned product(s) in clinical development or for marketed products Ensure that ICSRs contain accurate medical content through appropriate querying and obtained source data verification. Collaborate closely with Drug Safety staff providing medical expertise and guidance for proper gathering, evaluation, medical assessment, and follow-up of ICSRs. Review and/or Author an Analysis of Similar Events (ASE) for expedited cases. Identify clinically important cases and lead the discussion on such cases by liaising with the medical monitor of the respective clinical study to discuss next steps. Review global literature for assigned products for identification of ICSRs and assess their reportability. Contribute to aggregate safety data reviews, signal evaluation, interpretation and documentation for assigned project(s) or product(s) Provide medical input in the development and maintenance of RMPs for assigned product(s) Contribute to science sections of the aggregate reports for assigned product(s) Provide medical input for the Reference Safety Information (RSI) for assigned product(s) Contribute/lead, participate and support Benefit-Risk Team meetings for assigned project(s) and product(s) Provide safety input in study protocols, study reports or high-level summary documents for regulatory filings for assigned project(s) or product(s) Prepare and present safety data for Data Monitoring Committees for specified project(s) or product(s) Supervisory Responsibilities: No supervisory responsibilities. EDUCATION/EXPERIENCE/KNOWLEDGE & SKILLS: Education/Experience: M.D. degree required and a minimum of 5 years of experience post-residency with at least 2+ years of clinical experience post-residency; or, Equivalent combination of education and experience. Completion of an accredited medical or surgical residency program is required. Board certification is preferred. Experience/The Ideal for Successful Entry into Job: High level of medical competence with an ability to balance this with industry standards. A minimum of 5+ years of experience in a medical review role in the pharmaceutical industry with a strong understanding of relevant regulatory requirements. Prior experience in Oncology is preferred. Significant clinical experience (~ 5 years) may compensate for shorter experience in a pharmaceutical/biotech company Knowledge/Skills: Extensive knowledge of biotechnology/pharmaceutical sector drivers and practices Demonstrated and excellent knowledge of relevant international regulations, guidance and initiatives governing both clinical trial and post-marketing safety environments Demonstrates advanced skill and keen insight in gathering, sorting and applying key information to solve problems Demonstrates good organizational and planning skills by managing time, workload and resources of a team Leads and manages a team to execute on team objectives that contribute to accomplishing common functional and departmental goals Demonstrates clear and effective verbal and written communication. Provides timely and appropriate information updates. Speaks clearly and confidently in one-to-one situations and effectively presents information to cross-functional groups of team members and colleagues. Fosters collaboration among team members. Encourages teams to align on common goals. Engages internal and external stakeholders to build relationships. Good interpersonal skills and demonstrable ability to bring differing views to develop an agreed upon resolution Develops procedures, tasks and tools. Trains staff on departmental products, tools and data sources. Develops and maintains knowledge of cross-functional products, tools and data sources. Mentors junior team members. JOB COMPLEXITY: Capable of proactively assessing workload, trends, tasks and priorities for area of responsibility Plans and executes multiple activities Considers alternative methods and contingency plans to avoid potential issues Designs and implements solutions to address project level challenges, taking into consideration the broader impact Working Conditions: Notice to Recruiters/Staffing Agencies Recruiters and staffing agencies should not contact Exelixis, Inc. through this page. We require that all recruiters and staffing agencies have a signed contract on file and be assigned a specific search by our human resources department. Any resumes submitted through the website or directly by recruiters or staffing agencies that do not meet the above-mentioned criteria will be considered unsolicited and the company will not be responsible for any related fees. #LI-MB1 If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us! Our compensation reflects the cost of labor across several U.S. geographic markets, and we pay differently based on those defined markets. The base pay range for this position is $226,000 - $321,500 annually. The base pay range may take into account the candidate's geographic region, which will adjust the pay depending on the specific work location. The base pay offered will take into account the candidate's geographic region, job-related knowledge, skills, experience and internal equity, among other factors.In addition to the base salary, as part of our Total Rewards program, Exelixis offers comprehensive employee benefits package, including a 401k plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts. Employees are also eligible for a discretionary annual bonus program, or if field sales staff, a sales-based incentive plan. Exelixis also offers employees the opportunity to purchase company stock, and receive long-term incentives, 15 accrued vacation days in their first year, 17 paid holidays including a company-wide winter shutdown in December, and up to 10 sick days throughout the calendar year. DISCLAIMER The preceding job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Incident Reporting/Risk Management Full-time, $25.00 an hour. Come grow with us! South County Mental Health Center, Inc. is a private, non-profit Joint Commission Accredited Behavioral Healthcare provider located in South East Palm Beach County, Florida. Situated in the nationally designated city of Delray Beach, the Center provides a broad spectrum of inpatient and outpatient care to clients and their families in surrounding communities. You can make a positive impact in the community on day 1! The Incident Reporting job involves documenting and analyzing workplace accidents, injuries, or other significant events. The role focuses on capturing details, investigating causes, and recommending preventative measures to avoid future incidents. It's a crucial part of risk management, ensuring a safer work environment. Key Responsibilities of an Incident Reporting Role: Reporting to AHCA Incident Reporting System (AIRS) Submitting reportable incidents to DCF IRAS Incident Reporting and Analysis System Grievance Investigations if necessary, review of resolved grievance, log into Grievance log Incident Documentation: Thoroughly recording all relevant information about an incident, including the date, time, location, individuals involved, and a detailed description of what happened. Investigation and Analysis: Examining the incident to determine the root cause, contributing factors, and potential areas for improvement. Reporting and Communication: Preparing clear and concise incident reports, sharing findings with relevant stakeholders, and contributing to safety training and awareness programs based on trends identified. Report to QA Committee on findings Risk Management: Utilizing incident data to identify patterns, assess risks, and implement preventative measures to mitigate future incidents. Compliance: Ensuring adherence to relevant safety regulations and reporting requirements. Continuous Improvement: Reviewing and refining incident reporting procedures to enhance their effectiveness and efficiency. Any other assigned duties Skills and Qualifications: Critical thinking skills Strong Communication Skills: Ability to clearly articulate information, both verbally and in writing. Analytical Skills: Capacity to analyze data, identify patterns, and draw logical conclusions. Attention to Detail: Accuracy in recording information and identifying potential issues. Problem-Solving Skills: Ability to investigate incidents, identify root causes, and propose solutions. Technical Proficiency: Familiarity with relevant safety regulations, incident reporting systems, and potentially data analysis tools. Knowledge of Incident Management Processes: Understanding of the steps involved in incident response and resolution. Basic Computer Skills which includes Microsoft Office Suites (Proficiency in using Microsoft Word and Outlook) Ability to send, receive, and manage emails effectively. Internet Navigation: Comfortable with using web browsers and searching Writing Skills: Excellent writing and grammar skills Purpose of Responsibilities Improved Workplace Safety: By identifying and addressing hazards, incident reporting contributes to a safer environment for all employees. Reduced Risk: Analyzing incidents helps organizations identify and mitigate potential risks, minimizing the likelihood of future incidents. Enhanced Compliance: Accurate incident reporting ensures that organizations meet their legal and regulatory obligations. Education: Required Education: Bachelors in Health Services Administration or related field Required Experience: 1-year experience in health services Preferred: Masters in HSA or related field, Administrative experience, background in mental health Benefits At SCMHC we offer full-time employees a full benefit package. Just to name a few great benefits, we have health, dental, and vision. Also, because we know how important our own mental health is, we offer paid time off, and we will help do our part to set you up for future with a great 401k+match. Couple that with a competitive salary our amazing caring team, you cannot go wrong. Apply now. Because of the work we do in the community, a full background check is required for all staff. We are a drug free employer. South County Mental Health Center, Inc is an EOE.

Job DescriptionIncident Reporting/Risk Management Full-time, $25.00 an hour. Come grow with us! South County Mental Health Center, Inc. is a private, non-profit Joint Commission Accredited Behavioral Healthcare provider located in South East Palm Beach County, Florida. Situated in the nationally designated city of Delray Beach, the Center provides a broad spectrum of inpatient and outpatient care to clients and their families in surrounding communities. You can make a positive impact in the community on day 1! The Incident Reporting job involves documenting and analyzing workplace accidents, injuries, or other significant events. The role focuses on capturing details, investigating causes, and recommending preventative measures to avoid future incidents. It's a crucial part of risk management, ensuring a safer work environment. Key Responsibilities of an Incident Reporting Role: Reporting to AHCA Incident Reporting System (AIRS) Submitting reportable incidents to DCF IRAS Incident Reporting and Analysis System Grievance Investigations if necessary, review of resolved grievance, log into Grievance log Incident Documentation: Thoroughly recording all relevant information about an incident, including the date, time, location, individuals involved, and a detailed description of what happened. Investigation and Analysis: Examining the incident to determine the root cause, contributing factors, and potential areas for improvement. Reporting and Communication: Preparing clear and concise incident reports, sharing findings with relevant stakeholders, and contributing to safety training and awareness programs based on trends identified. Report to QA Committee on findings Risk Management: Utilizing incident data to identify patterns, assess risks, and implement preventative measures to mitigate future incidents. Compliance: Ensuring adherence to relevant safety regulations and reporting requirements. Continuous Improvement: Reviewing and refining incident reporting procedures to enhance their effectiveness and efficiency. Any other assigned duties Skills and Qualifications: Critical thinking skills Strong Communication Skills: Ability to clearly articulate information, both verbally and in writing. Analytical Skills: Capacity to analyze data, identify patterns, and draw logical conclusions. Attention to Detail: Accuracy in recording information and identifying potential issues. Problem-Solving Skills: Ability to investigate incidents, identify root causes, and propose solutions. Technical Proficiency: Familiarity with relevant safety regulations, incident reporting systems, and potentially data analysis tools. Knowledge of Incident Management Processes: Understanding of the steps involved in incident response and resolution. Basic Computer Skills which includes Microsoft Office Suites (Proficiency in using Microsoft Word and Outlook) Ability to send, receive, and manage emails effectively. Internet Navigation: Comfortable with using web browsers and searching Writing Skills: Excellent writing and grammar skills Purpose of Responsibilities Improved Workplace Safety: By identifying and addressing hazards, incident reporting contributes to a safer environment for all employees. Reduced Risk: Analyzing incidents helps organizations identify and mitigate potential risks, minimizing the likelihood of future incidents. Enhanced Compliance: Accurate incident reporting ensures that organizations meet their legal and regulatory obligations. Education: Required Education: Bachelors in Health Services Administration or related field Required Experience: 1-year experience in health services Preferred: Masters in HSA or related field, Administrative experience, background in mental health Benefits At SCMHC we offer full-time employees a full benefit package. Just to name a few great benefits, we have health, dental, and vision. Also, because we know how important our own mental health is, we offer paid time off, and we will help do our part to set you up for future with a great 401k+match. Couple that with a competitive salary our amazing caring team, you cannot go wrong. Apply now. Because of the work we do in the community, a full background check is required for all staff. We are a drug free employer. South County Mental Health Center, Inc is an EOE. Powered by JazzHR RDhhoHQ5MG