BHM Healthcare Solutions
  • 25-Oct-2018 to 24-Dec-2018 (EST)
  • Tampa, FL, USA
  • $108,000 to $120,000
  • Salary
  • Full Time

Healthcare Insurance, 401k Plan, Paid Holidays


Director of Quality Management and Compliance

Location:  Tampa, Florida

Salary:     $108,000-$120,000 Annually.  Compensation is commensurate with level of experience.

BHM Healthcare Solutions, Inc. (BHM) is seeking a Manager of Quality Management and Compliance to join our Behavioral Health and Medical Review services organization. BHM provides behavioral health and medical independent review services and performance improvement consulting to health plans, providers, ACOs, TPAs, workers' compensation, and other insurers nationally.

POSITION SUMMARY

The Director of Quality Management and Compliance ("Manager") is responsible for ensuring BHM meets the applicable standards imposed by all appropriate regulatory, credentialing, licensing, and accreditation agencies. The Manager is responsible for:

  • the tracking of applicable state and federal laws and regulations;
  • ongoing internal monitoring, auditing, and reporting designed to ensure consistent compliance by BHM and its contractors with applicable laws and regulations;
  • oversee BHM's prompt response to detected compliance issues, including the implementation of corrective actions to prevent future such issues; and
  • perform other related duties as assigned or as directed.

This position reports directly to the Chief Executive Officer.

SCOPE OF ROLE & RESPONSIBILITIES

  • Oversees the Regulatory Compliance program.
  • Is responsible for tracking applicable laws and regulations in the jurisdictions where the organization conducts business.
  • Ensures the organization's compliance with applicable laws and regulations through audits and other monitoring activities.
  • Responds promptly to detected compliance problems and takes corrective action as necessary. Provides information to BHM Quality Management Committee ("QMC") and its Leadership Team (LT) related to reports received or identified areas of concern. This information may be provided to the LT in open session or closed session as allowed by law.
  • Establishes, implements, and oversees systems for routine monitoring and auditing of compliance throughout the organization including but not limited to: annual program reviews, internal monitoring plans and documentation maintained by BHM business associates, and investigations of health care violations, regulations and policies.
  • Assists, reviews, and monitors overall health care compliance matters to include but not necessarily limited to: privacy incidents, breach incidents, and billing and coding issues.
  • Coordinates the identification, prevention, and prompt correction of identified compliance issues.
  • Under the direction of the Sr. Leadership, oversees and maintains an organizational Quality Management Program that promotes objective and systematic measurement, monitoring, and evaluation of organizational services and complies with any applicable accreditation standards.
  • Advises senior leadership when resources are needed for the daytoday operation of the QM program or the UR/IR program.
  • Chairs or co-chairs the Quality Management Committee (or UR/QMC) and ensures all necessary documentation is received by responsible persons, presented to committee, recorded, and maintained.
  • Supports the Clinical Advisory Committee, maintaining minutes and providing guidance regarding committee activities related to accreditation requirements.
  • Coordinates multi-disciplinary Quality Improvement Project (QIP) workgroups and ensures progress towards team established goals.
  • Develops the necessary policies and procedures, program descriptions and other such documentation necessary to support the utilization review/independent review program and accreditations.
  • Performs other responsibilities as needed. The omission of specific duties does not preclude the supervisor from assigning duties that are logically related to the position.

QUALIFICATION REQUIREMENTS

  • Bachelor's degree in a healthcare related field; Master's preferred
  • 5 years of management experience in healthcare quality management preferred
  • Knowledge and experience with relevant national accreditation entities (URAC, NCQA, etc....) preferred
  • CHC, CCEP or equivalent certification preferred upon hire or commitment to obtain within 1 year of hire required.
  • Demonstrated experience with HIPAA and HITECH preferred
  • Demonstrated experience with laws and regulations regarding Centers for Medicare and Medicaid Services (CMS) billing, coding, credentialing and documentation preferred
  • Demonstrated experience with the False Claims Act, Stark and Anti-Kickback Statute preferred

For more information about BHM, visit www.bhmpc.com.

 

BHM Healthcare Solutions
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