Director of Quality, Risk Management, and Com

FAMILY HEALTH CARE CENTER OF KALAMAZOO•Kalamazoo, MI

23h

About The Position

The Director of Quality, Risk Management, and Compliance (DQRC) provides strategic and operational leadership for the organization’s quality improvement, patient safety, risk management, regulatory compliance, credentialing, and privileging programs. The DQRC develops, implements, monitors, and improves systems that promote high-quality, safe, equitable, and compliant care while identifying and mitigating clinical and operational risks. The role ensures alignment with applicable federal and state regulations and HRSA, FTCA, NCQA, CMS, payer, accreditation, and organizational requirements. The DQRC leads quality assurance and performance improvement, risk assessments and incident management, compliance, credentialing and privileging, clinical policies, audits and monitoring, and organizational reporting. The role collaborates with Executive and Clinical Leadership, Medical and Dental Leadership, Operations, Human Resources, Information Technology, Health Information Management, Provider Enrollment, and other departments. It serves as a subject matter expert and advisor to leadership and governance bodies on quality, risk, compliance, provider competency, credentialing, privileging, and patient safety. The position operates primarily in a professional healthcare and office environment. It may require travel between organizational locations and attendance at external meetings, regulatory activities, and organizational events. The environment is generally quiet to moderate, with occasional exposure to outside weather conditions. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Requirements

Licensed healthcare professional with commensurate quality and risk experience.
Minimum 3–5 years of experience in a healthcare environment; progressive leadership experience is preferred.
Must be familiar with Medicare/Medicaid federal guidelines and agency programs serving the client population.
Operational experience in an FQHC.
Knowledge of healthcare administration, clinic philosophy, policies, and operating procedures.
Knowledge of fiscal management systems and techniques.
Knowledge of human resource management practices, including supervision and staff development.
Knowledge of governmental regulations and reimbursement requirements.
Demonstrated initiative, judgment, problem-solving, and decision-making skills.
Demonstrated ability to organize work to achieve clinic goals and objectives.
Ability to monitor quality control standards.
Valid Michigan driver’s license.
Ability to perform the essential duties satisfactorily, with reasonable accommodations where needed.

Nice To Haves

Master’s degree in health services, Nursing, or a related field.
Certified Healthcare Quality Professional (CPHQ) certification, or ability to acquire certification within one year of employment.
LEAN training.
Progressive leadership experience in a healthcare environment.

Responsibilities

Provide strategic leadership for the organization’s Quality Improvement/Quality Assurance program and continuous improvement framework; establish measurable goals, indicators, priorities, and sustainability strategies.
Monitor clinical quality measures, patient outcomes, operational performance, utilization, and other key indicators; identify trends and improvement opportunities.
Lead quality improvement projects, including project charters, interventions, action plans, timelines, measures, and sustainability plans; evaluate corrective and improvement actions.
Lead or oversee audits, monitoring, and performance assessments addressing policies, regulatory requirements, and evidence-based practices.
Partner with Clinical Leadership to address quality and patient safety gaps and support data-driven decisions; ensure quality activities support HRSA, FTCA, NCQA, HEDIS, UDS, payer, grant, and other applicable requirements.
Oversee quality incentive programs and reporting, and integrate quality improvement, patient safety, risk management, infection prevention, peer review, and compliance activities.
Chair the Quality Committee and coordinate quality reporting to Executive Leadership and the Board QA Committee.
Oversee collection, validation, analysis, and reporting of quality, risk, compliance, credentialing, and patient safety data; develop reports with Clinical Leadership and stakeholders, validate regulatory reporting data, monitor KPIs, and translate trends into recommendations.
Provide organizational leadership for risk management and patient safety; identify, assess, prioritize, and mitigate risks affecting patient safety, quality, compliance, operations, reputation, or financial performance.
Develop and maintain the annual Risk Management Plan and organizational and departmental risk assessments.
Oversee incident reporting, investigation, escalation, follow-up, and corrective action; lead or facilitate root cause and contributing-factor analyses and other structured investigations.
Identify recurring events, system failures, and emerging risks; develop prevention strategies; escalate significant events; and monitor corrective actions for completion and effectiveness.
Develop risk management policies, procedures, workflows, and monitoring processes; provide risk and patient safety education and consultation; chair the Risk Management Committee.
Oversee the FTCA program, including its annual application and supporting requirements, and monitor medical malpractice insurance outside FTCA; collaborate with legal counsel, insurers, clinical leadership, and Executive Leadership on significant risk matters.
Provide organizational leadership and oversight of credentialing and privileging, including initial credentialing, recredentialing, privileging, and ongoing provider monitoring within required timeframes.
Establish systems to track credentialing requirements, renewal dates, licenses, certifications, and supporting documentation; oversee verification of provider qualifications and maintain complete, accurate, current, secure, audit-ready files.
Oversee provider-specific clinical privileges based on education, training, experience, demonstrated competency, scope of practice, and supporting documentation; coordinate appointments, reappointments, privilege modifications, temporary and emergency privileges, and other privileging actions.
Chair or coordinate the Credentialing and Privileging Committee (CPC); document recommendations and present them for required approval; ensure decisions are communicated and documented.
Monitor credentialing compliance and escalate delinquent, incomplete, or high-risk files; partner with clinical leaders to evaluate provider competency and scope of practice and coordinate with Provider Enrollment, Human Resources, and Operations.
Identify and mitigate risks related to expired credentials, incomplete files, inappropriate privileges, or unauthorized practice; evaluate adverse information and maintain ongoing provider competency and qualification monitoring.
Develop and maintain credentialing and privileging policies, procedures, workflows, and monitoring tools; report compliance, outstanding requirements, privileging status, and risks to leadership and governing bodies; maintain review readiness.
Lead and oversee the organizational compliance program; ensure compliance with applicable laws, regulations, funding requirements, and healthcare standards; serve as a primary resource for HRSA, FTCA, HHS, NCQA, CMS, payer, and other regulatory requirements.
Develop, review, and update compliance policies and procedures; conduct audits, monitoring, and assessments; identify gaps, develop corrective action plans, and monitor implementation and effectiveness.
Maintain regulatory documentation and evidence of compliance; serve as a primary contact for regulatory correspondence and inquiries; coordinate responses to requests, audits, surveys, investigations, and corrective actions.
Monitor regulatory changes and communicate requirements and implications to leadership and staff; provide compliance education and promote ethical conduct, accountability, transparency, and regulatory readiness.
Develop, review, revise, and maintain Quality, Risk Management, Compliance, Credentialing, Privileging, and Patient Safety policies and procedures; align them with regulatory requirements, organizational practices, and evidence-based standards.
Coordinate appropriate leadership, committee, and Board review and approval of policies; maintain systematic policy review and regulatory-update processes.
Lead or coordinate applicable organizational committees, including the Quality Committee and subcommittees, Risk Management Committee and subcommittees, Credentialing and Privileging Committee, Peer Review Committee, and Board Quality Assurance Committee; prepare agendas, reports, meeting materials, minutes, action items, follow-up, and regulatory documentation.
Lead, mentor, and develop Quality, Risk Management, Compliance, and Credentialing functions; establish goals and accountability measures; supervise assigned staff, provide coaching and feedback, and conduct performance evaluations.
Build staff expertise, allocate resources, integrate functions into daily operations, and promote collaboration, accountability, continuous improvement, and professional development across clinical and operational teams.
Develop and provide training in quality improvement, patient safety, risk management, incident reporting, compliance, credentialing and privileging, regulatory requirements, and policy and procedure compliance; identify training needs and document required education.
Maintain readiness for regulatory and accreditation surveys; coordinate preparation for HRSA, FTCA, NCQA, CMS, payer, and other audits, surveys, and reviews; maintain supporting evidence and coordinate responses to findings and corrective action requirements.
Monitor grant and funding requirements and stay current with healthcare regulations, accreditation standards, and industry best practices; communicate regulatory changes and implications to leadership.
Prepare and present reports on quality, risk management, and compliance activities to senior management and other audiences, including the Quality Committee, provider group, health center teams, Executive Team, and Board Quality subcommittee.
Coordinate the bi-monthly Board Quality Subcommittee, monthly Continuing Quality Management Committee, and monthly subcommittees; coordinate and manage quality improvement projects.
Develop, update, and maintain Quality Improvement/Assurance and Clinical Application policies and procedures and present them to leadership for approval as needed.
Work with Clinical Leadership and Practice Management to create custom reports for quality care and operations; respond to ad hoc internal data requests from leadership.
Oversee Clinical Applications to support quality, data accuracy, and cohesive workflows, including EHR workflows.
Communicate effectively with staff, patients, and stakeholders regarding quality, risk, and compliance issues; perform other duties as assigned.