Program Manager III / Quality Management & Compliance Officer

State of South Carolina • Richland County, SC

13d • Onsite

About The Position

Are you passionate about making a real difference in people's lives? Join our team at the Office of Mental Health where we are dedicated to providing compassionate and accessible care to our community. We are seeking a Program Manager III / Director of Quality Management and Compliance who is motivated to help individuals and families navigate life's challenges and achieve long-term wellness. If you want to use your skills to build a healthier, more resilient community, we encourage you to apply. This position is located at the SC Department of Behavioral Health and Developmental Disabilities (DBHDD) - Office of Mental Health, Central Office, 400 Otarre Parkway Cayce, SC 29033. As the Compliance Officer for SCOMI-, you will manage compliance activities that ensure that rules and regulations are followed properly. Direct and manage the Division of Quality Management & Compliance. Advise the leadership of the Office of Mental Health and its facilities statewide regarding all areas included in the Division -Medicaid and Medicare Operations, Compliance, HIPAA Privacy, Quality Assurance, Credentialing and Privileging, Accreditation and Education, Training, and Research (ETR).

Requirements

• A bachelor's degree and relevant program management experience.
• A Master's degree or Ph.D. in Healthcare Administration, Psychology or related field, OR Bachelor's degree in Health Information Management; with five (5) years of relevant program experience in compliance, healthcare administration, quality assurance,. and HJPPA Privacy.
• South Carolina licensure appropriate to profession.
• Knowledge of healthcare compliance activities as well as federal and state regulations pertaining to these activities.
• Understand systems and operations of health and human services delivery field.
• Possess excellent written and verbal communication and decision-making skills especially when facing confrontations and challenging situations.
• Ability to provide leadership in areas of responsibility.

Nice To Haves

• Experience in HIPAA / privacy and knowledge of credentialing processes and Health Information Management.
• Knowledge and experience in billing or CPT coding.
• Bilingual abilities in English and Spanish (or another language) are a plus.
• Management experience in a large healthcare setting and significant supervisory experience.
• Knowledge and experience in state and federal information privacy laws. including but not limited to HIPAA.
• Knowledge of accreditation standards (CARF, Joint Commission).

Responsibilities

• Direct and monitor the agency's Compliance program.
• Maintain, update and monitor the implementation of the agency's Compliance Plan to its fullest and in conformance with federal and state regulations.
• Monitor and ensure compliance of the agency with Medicare and Medicaid contract and related federal and/or state requirements.
• Ensure proper resolution to compliance audit findings and investigations.
• Ensure OMII staff receive needed education on compliance and ethical pract
• Direct and manage the agency's HIPAA Privacy in conformance with federal and state regulations.
• Ensure proper management and disclosure of PHI, and proper reporting of breaches.
• Direct and manages the agency's Quality Assurance and Utilization Review activities in onformance with third party payer and accreditation standards of care.
• Ensure timely consultation, education and direction to the Centers and Facility Directors and staff on the delivery of services in accordance to Medicaid and Medicare standards of practice.
• Advise the leadership of the agency on issues related to the quality of services provided, practices and areas for improvement.
• Monitor corrective action plans and quality improvement plans system-wide.
• Manage Office of Credentialing and Privileging, assuming responsibility and accountability for state-wide credentialing of staff and ensuring the efficiency and compliance with all appropriate NCQA accreditation requirements and regulations.
• Direct and manage the Education, Training and Research area as a vital function of a competent and educated workforce.
• Serve as the DHHS Liaison for OMH and collaborate with DHHS on the development and implementation of new initiatives and changes affecting the delivery of services by OMH.
• Review federal policies and initiatives stemming from Medicaid, Medicaid Managed Care, Medicare and other payer sources in light of the potential impact to the agency and advises leadership on these matters for proper decision making and planning.
• In consultation with OMH Senior Management, develops initiatives related to issues of program development and billing as they relate: to Medicaid and Medicare.
• Manage contracts with MCOs including value-based contracts; collaborates to develop quality improvement projects; serve as primary point of contact for all MCOs for contract review and approval process.

Benefits

• Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children.
• 15 days annual (vacation) leave per year
• 15 days sick leave per year
• 13 paid holidays
• Paid Parental Leave
• S.C. Deferred Compensation Program available (S.C. Deferred Compensation)
• Retirement benefit choices
• State Retirement Plan (SCRS)
• State Optional Retirement Program (State ORP)

What This Job Offers

• Job Type: Full-time
• Career Level: Manager