Director of Policy, Compliance, and Innovation

Neighborhood Health•Nashville, TN

About The Position

The Director of Policy, Compliance, and Innovation works closely with members of the Executive Team to design and implement new workflows and business processes to achieve highly specific business goals. The Director provides a true systems perspective to ensure each employee or partner involved a workflow can complete their specific tasks as efficiently and effectively as possible. The Director also has primary responsibility to design and track key management reports to identify potential obstacles or points of failure and resolve issues there as they arise. Using a rapid-cycle, iterative Plan-Do-Study-Act (PDSA) approach, the Director assesses and helps implement potential improvements. The Director performs this work by quickly becoming steeped in technical requirements of key partners as these evolve. The Director develops a thorough understanding of The Joint Commission accreditation requirements, the NCQA recognition standards for Patient-Centered Medical Home recognition, and the HRSA requirements for federally qualified health centers (including those related to the FTCA malpractice program). The Director also develops expertise in the requirements of contract agreements with key partners, including but not limited to TennCare managed care organizations (MCOs) and Medicare Accountable Care Organizations (ACOs). Given the importance of these programs to the Directors work, the Director has primary responsibility for liaising with these partners and ensuring Neighborhood Health’s documented adherence to their respective requirements. The Director also has primary responsibility for overseeing Neighborhood Health’s Risk Management and Patient Safety Plan and shared responsibility for the implementation and monitoring or our Quality Improvement-Quality Assurance Plan.

Requirements

Bachelor’s degree plus 4 years relevant work experience; or 6 years of relevant work experience in a community-based organization, public health or health care setting.
Knowledge of, and ability to accommodate, the social, cultural and linguistic needs of people from diverse backgrounds.
Highly proficient in project planning and management with strong organizational skills, including the ability to manage several projects simultaneously, respond to tight timelines and operate effectively in a fast-paced, detail-rich environment.
Excellent oral and written communication skills with a demonstrated awareness of the individual needs of clients and communities.
Diplomatic skills and the ability to exercise proper judgement, discretion, and be flexible in response to changing organizational needs.
Highly motivated with an ability to work independently and as a collaborative member of a team
Ability to work with a minimum of supervision

Responsibilities

Develop and implement “start-up” initiatives
Propose initiatives to improve organizational performance consistent with the annual strategic foci and broader Strategic Plan
Design, test, and implement new workflows, new business processes, and/or new business units
Develop project plan to transition successful “start-ups” to an appropriate, embedded place within the organization
Manage accreditation/recognition status and ensure ongoing compliance with NCQA, The Joint Commission (TJC), and select HRSA programs
Assemble, upload, and submit all required NCQA submissions to the NCQA PMCH platform and manage all components of the NCQA process to maintain PCMH recognition for all locations
Assemble, upload, and submit all required submissions to The Joint Commission and manage all components of the TJC process to maintain ambulatory care and PMCH accreditations
Assemble and upload the following submissions to HRSA’s Electronic Handbook (EHB) so the CEO can submit prior to the deadline: FTCA annual re-application; Progress reports (except financial reports) on grants administered by HRSA
Ensure the organization drafts and presents to the Board: Annual risk management report, which includes completed risk management activities, a compilation of near misses and adverse events, status of the health center’s performance relative to established risk management goals, and proposed risk management activities that relate and/or respond to identified areas of high organizational risk (normally in May); Updated Hazard Vulnerability Analysis (normally in May); Updated Prioritized Risk of Infection Analysis (normally in May); Updated Risk Management Training Plan (normally in November); Updated Environment of Care (ECO) goals (normally in November); Updated Needs Assessment (with ZIP code analysis) on an annual basis (normally in early March); Updated Patient Experience Analysis (normally in March)
Manage Patient Centered Medical Home (PCMH) programs with TennCare managed care organization (MCO)
Design, test, and implement business processes to improve organizational performance and maximize revenue
Supervise a limited number of PCMH staff, specifically regarding patient outreach and engagement activities
Generate patient outreach lists using Azara and other tools in a HIPAA-compliant manner
Monitor performance and regularly brief the CEO
Serve as PCMH liaison with each MCO and serve as organizational representative at monthly meetings to share program performance updates
Attend regional MCO collaborative meetings throughout the year
Manage social determinants of health (SDoH) programs with TennCare managed care organization (MCO) in collaboration with the CEO
Design, test, and implement business processes to improve organizational performance and maximize both “grant” funding and reimbursement claims/revenues
Monitor performance and regularly brief the CEO
Produce grant reports as assigned by the CEO
Collect and curate “success” stories for funders
Serve as SDoH liaison with each MCO
Manage value-based care and accountable care organization (ACO) initiatives
Design, test, and implement business processes to improve organizational performance to: Maximize reimbursements/revenues; Minimize administrative burden and payer-specific deviations from workflows of providers and staff
Monitor performance and regularly brief the CEO
Serve as SDoH liaison with each payer or ACO
Ensure we generate and send (by email, mail, etc.) the semi-annual patient notices required by federal regulations and ACO agreements
Manage certain IT related functions
Manage user access to Azara population health
Manage alerts on daily huddle reports
Manage appointment reminder content and cadence
Manage patient outreach campaign content and population health reports for them
Conduct root cause analysis when staff report possibly issues with patient communications and automated scheduling
Manage patient self-scheduling and appointment accelerator parameters and provider changes
Manage virtual programs
Manage the Collaborative Practice Agreement and Pharmacy Fellowship programs through Belmont College of Pharmacy and Health Sciences
Maintain comprehensive policy library
Ensure written policies conform to style standards (e.g., use of clear subjects with active tense verbs, etc.)
Ensure we have all required policies to comply with federal and state rules, accreditation standards, and contract obligations
Maintain accurate, up-to-date inventory of policy documents and ensure each is available on SharePoint
Track due dates for reviews of policies, protocols, and other key documents and ensure appropriate leadership team members complete revisions at least 60 days prior to the “revise by” date so as to allow for reviews by staff-level and Board committees
Draft new policy documents upon request (or with approval) of Chief Executive Officer (CEO)
Manage regulatory compliance processes
Submit RDH xray registrations in consultation with the Director of Dental Services
Ensure timely submission of CLIA waiver renewals, etc.
Ensure timely submission of TDMHSAS annual licensure renewal
Ensure timely submission of Ryan White Program Services Report (RSR) (normally in February) and quarterly Ryan White updates
Monitor compliance with patient notifications regarding abnormal Paps, Cologuard test results, INR test results (for patients taking warfarin), etc. and produce quarterly quality reports
Monitor compliance with on-call provider response time each week and produce quarterly quality reports
Provide back up to the Privacy Officer on HIPAA-related matters
Support overall clinic compliance efforts by backing up the Quality Coordinator with the following activities: Conduct clinic tracers; Assume allocated compliance responsibilities to manage fire drills, sign audits, etc. at specific locations; Investigate and document findings for incident reports assigned for review; Investigate and document findings for patient complaints assigned for review
Completes FTCA-required risk management training each year (normally by June 30th)
Other duties as assigned