Director Of Compliance (2001647)

Catholic Charities, Archdiocese of New York•New York, NY

41d•$115,000 - $120,000•Onsite

About The Position

The Director of Compliance works with Beacon of Hope (BOH) staff to ensure programs remain in compliance with applicable regulatory standards set forth by the New York State Office of Mental Health (OMH) and provides supervision to the Quality Improvement Manager. Major areas of responsibility include serving as a liaison with external regulatory entities, assessing the quality of program services, facilitating staff development, ensuring HIPAA and Corporate Compliance, and performing Administrative and/or program related duties as directed.

Requirements

Seven years of experience working in compliance
Master’s degree in a mental health discipline is preferred.

Nice To Haves

Five years of experience working in and/or with a government contracted program preferred.
Five years of experience working with a special needs population preferred.

Responsibilities

Lead the Quality Improvement Department and supervise the Quality Improvement Manager.
Serve as BOH’s representative and gatekeeper for regulatory entities and external provider support systems to fulfill compliance requirements, support care coordination, submit reports and maintain operations.
Manage BOH’s electronic health record by serving as an internal Help Desk for staff and communicating with the vendor to troubleshoot issues and plan for changes.
Oversee BOH’s participation in Regional Health Information Organizations, provide training to staff around such, and ensure all required documentation is available and current.
Populate and analyze data for the quarterly BOH Divisional Board Report
Develop, implement and analyze Consumer Satisfaction Surveys and Program Evaluation Studies.
Monitor the provision of services to Identify operational improvements and recommend plans for such.
Create new forms for implementation consistent with operational needs and requirements.
Prepare and update policies and procedures consistent with regulatory requirements.
Receive and track client concerns and grievances, investigate when indicated, recommend a course of action, provide a response, and prepare related reports.
Maintain communication with the New York State Office of Mental Health, The Justice Center, and/or NIMRS/WSIR regarding all reportable incidents.
Prepare the agenda, as well as tracking and trending reports for internal incidents. Facilitate the committee meeting and write-up the minutes.
Conduct investigations under the direction of BOH leadership and/or in coordination with The Justice Center.
Audit client case records, prepare findings reports, conduct findings review meetings, and provide follow-up training to staff as needed.
Audit documentation for submission, prepare related reports and resolve client issues impacting billing. Work in coordination with the Finance Department around such, as needed.
Train staff in compliance with audit requirements, conduct environmental assessments, coordinate peer audit reviews, and perform mock licensing and monitoring audits.
Participate in Licensing audits and Monitoring Reviews. Assist in the preparation of Corrective Action Plans as needed.
Maintain and update HIPAA policies and procedures to ensure consistency with requirements for such.
Investigate HIPAA & Compliance related concerns, make notifications as required and prepare reports.
Manage requests for Protected Health Information and prepare responses.
Monitor and evaluate the Corporate Compliance risk areas and develop plans to mitigate such.
Annually draft and update the Compliance Work Plan, including training, monitoring, auditing, and responding to compliance issues.
Update policies and procedures designed to ensure Corporate Compliance.
Participate in training of Board members, staff and contractors regarding Corporate Compliance.
Respond to concerns regarding Corporate Compliance and investigation as directed by agency leadership.
Prepare the Corporate Compliance quarterly reports, facilitate the bi-annual Compliance meetings, and write up meeting minutes for the Divisional and CCCS Board Meetings.
Builds and maintains a comprehensive understanding of laws and regulations for property management.
Reviews and reports on the status of all lease-related documentation to ensure such is current.
Reviews and tracks housing inspection documentation including photographs to promote safe environments and accountability in apartment programs.
Engages in scheduled and unscheduled program visits, including community-based apartments, and prepares reports summarizing visits.
Prepares reports on clients’ benefits and entitlements to identify residents in need of additional support.
Participates in the non-payment and/or holdover eviction process to ensure compliance with internal policies and procedures as well as legal requirements for such.
Tracks the status of outstanding property management related activities to provide checks and balances on apartment repair issues.
Develop an annual staff training schedule in consultation with BOH leadership.
Works with BOH leadership to secure consultants for training and provide support as needed.
Facilitates ongoing employee training during times that are consistent with program and staff needs.
Adhere to personnel and residential policies and procedures as outlined in the CCCS Personnel Policies and Procedures Manual and BOH Policies and Procedures Manual.
Perform other duties consistent with the goals and objectives of the department and its programs, as assigned by Beacon of Hope Administrators.