Compliance Manager

PACE Organization of Rhode Island•East Providence, RI

About The Position

Reporting to the Chief of Organizational Performance, the Compliance Manager serves as the health care compliance subject matter expert for PACE-RI. The CM provides oversight of organizational compliance with regulatory and performance improvement standards as determined by federal, state, and accrediting bodies. This position is instrumental in ensuring a culture of compliance within the organization, setting the foundation for the delivery of high-quality care to the participants we serve. The Compliance Manager is responsible for the development and implementation of PACE-RI’s corporate compliance and risk management programs as well as accreditation and licensing programs and activities. With the assistance of the Compliance Associate, this role supports the operations of the interdisciplinary teams through guidance and education regarding regulatory requirements.

Requirements

Ability to maintain confidentiality
Ability to prioritize tasks and meet project deadlines
Proficiency with MS Office Suite or similar software
Dependable and punctual with ability to maintain consistent attendance
Ability to read, write and comprehend English
Ability to maintain sound judgement under stress and communicate effectively
Ability to research and analyze data, draw conclusions, and resolve issues
Ability to read, interpret, and apply policies, procedures, laws, and regulations
Bachelor's Degree, Required
1 to 3 years of compliance experience, required
1 to 3 years of experience with health care regulations and reporting requirements, required
1 to 3 years of staff management experience, required
Driver's License & access to reliable transportation: community-based travel required.

Nice To Haves

Master's Degree, Preferred
1 year of experience working with a frail or elderly population, preferred
Certificate in Health Care Compliance strongly preferred

Responsibilities

Develops, implements, and monitors PACE-RI’s Corporate Compliance and Risk Management Programs, including the creation and upkeep of policies and procedures that guide the organization to the highest levels of regulatory compliance and lowest levels of avoidable risk.
Distributes information and alerts to all staff regarding HIPAA and privacy practices; collaborates with managers to ensure all staff uphold the privacy of PACE participants.
Assists managers in ensuring all staff are aware of their compliance-related responsibilities, provides proactive and remedial education to staff.
Serves as organizational lead for PACE- CMS survey process; ensures an "always ready" approach to the survey through ongoing audits, staff education, mock surveys, etc. With leadership, facilitates organizational response to audit and any corrective action plans that may result.
Creates and monitors completion of compliance projects and corrective action plans resulting from deficiencies found through internal audits or regulatory surveys from external entities.
Supervises the Compliance Associate, providing subject matter education, providing growth opportunities, and delegating tasks as appropriate.
Monitors Complaints Tracking Module (CTM) in HPMS and PACE-RI Compliance Hotline, tracks calls received, investigates allegations, and reports on issues as needed.
Supports the Finance Department in the successful completion of the CMS 1/3 Financial Audit, provides information and participates in interviews with auditors.
Collaborates with Finance Department and Pharmacist regarding the Drug Management Program and Part D issues.
Conducts compliance investigations into allegations of fraud, waste, abuse, or misconduct. Maintains detailed documentation of all allegations, investigations, and findings.
Creates structure for regular auditing of medical charts, care plans, and CMS data sets (universes); conducts audits; creates process for reporting results and enacting remediation and education as indicated.
Manages PACE-RI’s risk management activities; co-facilitates monthly Risk Management meetings, ensures reports are accurate and actionable.
Supports PACE contract compliance through collaboration with Contract Manager; reviews vendor audits and advises Contract Manager on corrective action measures as needed.
Presents compliance related activities to Quality and Compliance Committee on a quarterly basis and Full Board upon request.
Ensures completion of regular summary reports of compliance activities. Makes recommendations for actions to be taken to correct weaknesses or to improve strengths.
Actively engages in meetings and communications among quality, data, and compliance staff so that these areas work collaboratively and produce organization-level reports of their observations, recommended actions, and improvement plans.
Serves as PACE liaison with DOH regarding surveys and regulatory questions. Establishes a system for monitoring and timely processing all required DOH licensure. Maintains database of all PACE DOH licenses.
Represent PACE at participant appeals hearings.
Monitors HPMS memos, maintains tracking grid of HPMS/CMS deliverables to ensure on-time submissions.
Prepares staff for CMS Quarterly calls; facilitates CMS Quarterly calls.
Responsible for providing staff education on Fraud, Waste, and Abuse at new hire orientation and annually, at minimum.
Assists with maintenance of PACE-RI's policies and procedures, oversees the development, revision, and annual review of Compliance and Risk related documents.
Implements annual departmental audit system to identify areas of non-compliance; uses data to inform decision making and action steps.
Reads and organizes NPA,CMS, and HPMS memos and delegates responsibilities to staff as needed.
Collaborates with and supports Canopy Care Solutions initiatives, integrating them where opportunities arise.
Performs other related duties as required and assigned.