Managed Care Recruiters

561.439.3234

Example job descriptions

JOB SUMMARY:  Working with the Chief Medical Director, oversees medical care for    products and services and oversees the health care needs of the membership. Serves as a medical manager and policy advisor to the company and health plan Chief Medical Director. Is accountable for and provides professional leadership and direction to the utilization/cost management and clinical quality management functions. Works collaboratively with other plan functions that interface with medical management such as provider relations, member services, benefits and claims management, etc. Assists (as determined by the plan Chief Medical Director) in short and long range program planning, total quality management (quality improvement) and external relationships. Works with Corporate Health and Medical Affairs for support, assistance and direction in overall medical management effectiveness. Reports all issues of clinical quality management to the health plan Chief Medical Director. Collaborates with the Chief Medical Director and other health plan medical directors on national medical policies and carries out national medical policies at the health plan in collaboration with the health plan CEO.
PRIMARY RESPONSIBILITIES: 
1.     Responsible and accountable to the Chief Medical Director for helping to manage health plan medical costs and assuring appropriate health care delivery for   health plans, products and services. Reports organizationally to the Chief Medical Director of the Health Plan; has a dotted line relationship to the Chief Medical Officer.
2.     Plans, organizes, and directs the professional medical services program, consisting of all primary and specialty services for in-patient, out-patient, preventive and wellness programs.
3.     Designs and implements health plan medical policies, goals and objectives.
4.     Provides professional leadership and direction to the functions within the Medical Management Department (Utilization/Cost Management and Clinical Quality Management)
5.     Responsible for and assists with the development of budgets, staffing plans and medical loss ratio projections, assuring the adequate allocation of resources to the medical management functions.
6.     Responsible and accountable for implementing the Utilization/Cost Management Program and Clinical Quality Improvement Program.
7.     Assists the Chief Medical Director with activities to promote positive community relations.
8.     Assures plan conformance with legal and regulatory requirements
9.     Assists the Chief Medical Director in creating and maintaining a system that gives feedback to providers individually and collectively regarding managed care effectiveness of individual providers and networks.
10.     Assists the Chief Medical Director in designing and implementing corrective action plans to address issues and improve plan and network managed care performance.
11.     Collaborates with Corporate Medical Affairs and the health plan Chief Medical Director in creating and maintaining programs that incentivize providers to achieve selected utilization/cost and quality outcomes.
12.     Participates in policy review, performs analysis and makes recommendations.
13.     Participates in the retrospective review and analysis of Plan performance from summary data of paid claims, encounters, authorization logs, compliant and grievance logs and other sources.
14.     Achieves and maintains benchmarked utilization and cost management (UM) goals and clinical quality improvement (QI) objectives.
15.     Provides periodic written and verbal reports and updates as required in the Quality Management Program description, the Annual Work Plan and  Community Care policy and procedures to various plan committees, the health plan Chief Medical Director and Corporate Medical Affairs.
16.     Supports URAC, AHCA and NCQA qualification activities. Prepares for site visits and responds to accrediting and regulatory agency feedback.
17.     Supports pre-admission review, utilization management, and concurrent and retrospective review process.
18.     Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review, outreach programs, HEDIS reporting, site visit review coordination, triage, nutrition service review, provider orientation, credentialing, profiling, etc.
19.     Conducts quality improvement and outcomes studies as directed by the state Departments of Health, the Quality Management Committee, Medical Advisory Committee, Peer Review Committee and management. Reports findings.
20.     Participates in the grievance process with the Chief Medical Director, insuring a fair outcome for all members.
21.     Monitors member and provider satisfaction survey results and implements changes as needed to increase satisfaction and assure that satisfactory relationships are maintained between network and plan participants.
22.      Participates actively in provider recruitment.
23.     Assists the contracting process of providers, hospitals, ancillary providers, and emergency and other support services, and evaluates the medical aspects of provider contracts.
24.     Chairs (or delegates leadership of) Advisory Committees of the health plan which include (but are not limited to) the Peer Review Subcommittee and the Credentialing Subcommittee of the Quality Management Committee.
25.     Participates in key marketing activities and presentations.
26.     Promotes wellness and ensures programs of prevention, education and outreach to members and providers consistent with company’s mission, vision and values.
27.     Maintains up-to-date knowledge of new information and technologies in medicine and their application to the  health plan.
28.     Performs and oversees in-service staff training and education of professional staff.
29.     Represents  at medical group meetings, conferences, etc.
30.     Participates in the development of strategic planning for existing and expanding business. Recommends changes in program content in concurrence with changing markets and technologies.
31.     Participates in key marketing activities and presentations, as necessary, to assist the marketing effort.
32.     Ensures that the Utilization Management Program is available on a 24 hour basis to respond to authorization requests for emergency and urgent services and is available, at a minimum, during normal working hours for inquiries and authorization requests for non-urgent health care services.
33.     The Associate Medical Director must ensure that a covered person enrolled in the Plan is permitted to:
a.        choose or change a primary care physician from among participating providers in the provider network; and
b.        when appropriate, choose a specialist from among participating network providers following an authorized referral, if required by the carrier, and subject to the ability of the specialist to accept new patients.
34.     Performs other duties as requested or assigned.
Education and Experience:

 
Knowledge and Skills:
·       Management skills to meet the organizational goals.
·       Must possess excellent communications skills to interface with providers, staff, and management.
·       Knowledge of medical, quality improvement and UM practices in a managed care environment.
·       Knowledge of regulatory and accreditation agencies and requirements.
·       Able to manage multiple priorities and deadlines in an expedient and decisive manner.
·       Able to manage difficult peer situations arising from medical care review.
·       Appreciation of cultural diversity and sensitivity towards target population.
 

Example job description

JOB DESCRIPTION

TITLE:             QUALITY IMPROVEMENT COORDINATOR                 Grade: 7
REPORTS TO: Director Quality Improvement, Accreditation                  Status: Exempt
SUPERVISES:  N/A
APPROVED BY:  Director, QI, Accreditation and Regulatory Compliance           Date Approved:            11/2005
HUMAN RESOURCES: Sr. Director of Human Resources                      Date Reviewed:  3/2006

JOB SUMMARY:  The Quality Improvement Coordinator is responsible for coordinating quality improvement activities throughout the organization.  This individual plays an integral role in monitoring key organization quality improvement indicators, ensuring that QI indicators are reported and documented.  Assisting and educating staff to organizational compliance with accreditation and regulatory standards as well as coordinating organizational quality improvement initiatives and processes.  The Quality Improvement Coordinator is responsible for reporting quality improvement data, investigating quality improvement complaints and adverse occurrences, and performing quality improvement studies. 
MINIMUM QUALIFICATIONS: 
Education:                   Registered Nurse with a current license without restrictions or sanctions in the state  and a BA, BS, or BSN degree. MA, MS, or MSN preferred. CPHQ,  NCQA & URAC experience preferred
 
Experience:                 At least three (3) years of nursing experience; critical care and behavioral health care experience are preferred; at least five (5) years of experience related to healthcare quality improvement activities/process improvement/outcomes measurement.
Knowledge/skills:       
•      Strong critical thinking skills, communication skills, and documentation skills
·                Statistical ability to analyze data
•      Working knowledge of utilization management/case management/disease    management preferred. 
•      Strong problem solving and decision making skills. 
•      Strong computer skills and experience with Microsoft Office Suites including the development of spreadsheets.
·                Must be able to work independently at times
ACCOUNTABILITIES:
                        Job Performance/Responsibilities:    
·        Coordinate, attend, and support the COMPANY Quality Improvement Committee structure, functions, and monthly meetings;
·        Assist in the monitoring  compliance with all accreditation and regulatory standards;
·        Assist and coordinate the implementation of organizational wide quality improvement processes;
·        Assist in the evaluation of the effectiveness of quality improvement program;
·        Coordinate and assist in planning and providing organization-wide education pertaining to accreditation standards, regulatory standards, and quality improvement policies and procedures and processes.
·        Monthly reporting of quality improvement initiatives and data;
·        Document internal quality improvement policies and procedures;
·        Coordinate and conduct quality improvement studies as indicated;
·        Enhance effective interdepartmental communication to ensure timely reporting of quality data;
·        Develop and implement QI audit, reporting, and monitoring tools
·        Evaluate and review the program descriptions for each of COMPANY’S clinical programs, including the quality improvement program;
·        Coordinate and conduct analysis of member, practitioner, and client satisfaction surveys;
·        Investigate adverse occurrences and quality complaints;
·        Monitor key organizational quality improvement indicators;
·        Document, develop, and/or coordinate corrective action plans in response to client and/or accreditation/regulatory audits.
·        Monitor follow-up activities in relation to corrective action plans;
·        Assess opportunities for improvement and propose solutions ;
·        Perform other duties as indicated by department director and/or Chief Medical Officer and SVP Operations 

                       Customer Services-Internal:

·   Support a positive working environment;
·   Identify and resolve potential personnel/peer problems and issues proactively, readily utilizing the Director of Quality Improvement, Accreditation and Regulatory Compliance as a resource;
·   Communicate to Director of Quality Improvement, Accreditation and Regulatory Compliance all problems, issues and/or concerns as they arise; 
·   Maintain a courteous and professional attitude when working with all COMPANY staff members and the management team;
·        Function as role model and healthcare leader when working with all COMPANY staff;
Participate in team meetings, as designated.

                       Customer Service-External:

·        Maintain a professional attitude/image when communicating with COMPANY visitors, customers, and/or clients;
·        Collaborates with COMPANY clients/customers/audit/surveyors in a professional manner;
·        Report all quality improvement data/issues to COMPANY clients in a timely manner;
·        Supports/maintains positive relations with COMPANY clients/customers.

 

Example job description


 
JOB DESCRIPTION

TITLE: DIRECTOR OF CARE MANAGEMENT                                                  GRADE:   12
REPORTS TO: Executive Vice President of Customer Delivery                          STATUS:  Exempt
SUPERVISES:  All Clinical Operations Staff for Nurse Triage, Case Management and Medical UM
APPROVED BY:  Executive Vice President of Customer Delivery          DATE APPROVED:  11/ 2006
HUMAN RESOURCES: Senior Director of Human Resources                DATE REVIEWED:  11/2006
                       

JOB SUMMARY:  The Director of Care Management is a full time position, responsible for assisting in the development and implementation of operational, clinical and functional support for the following programs:  Nurse Triage, Utilization Management, and Case Management.   The Director (1) directs and coordinates all operations to ensure compliance with product development/management, policy and procedures, accreditation, and regulatory standards; (2) provides input into Information Services development/management; (3) offers input and works with the appropriate departments to support the development and launch of new programs; (4) works with clients to deliver quality products and provide excellent customer service; (5) assists product development/management, marketing and sales with the development of product collateral and RFP responses, and assists with presentations for prospective clients; and (6) manages all inbound and outbound call center functions to meet established productivity, performance, and quality standards. 
SCOPE OF PRACTICE: 
Case Management, according to the Case Management Society of America, is defined as; “a collaborative process of assessment, planning, facilitation for options and services to meet an individual's health needs through communicating available resources to promote quality cost-effective outcomes.” This service is recognized as an organized process designed to ensure the medical necessity and cost effectiveness of a proposed service. Case Management is designated to promote optimal recovery and rehabilitation by professional involvement in the rehabilitation process
MINIMUM QUALIFICATIONS: 
Education:          Licensed registered nurse with current, unrestricted license required. BS in nursing or Certification in Case Management (CCM) is required. Certification in CM required within 12 months of accepting the position.
Experience:          5 years experience in Triage or Utilization Management or Case Management, and/or other managed care or cost management program, with at least 3 of the 5 years in direct supervision of Case Management required.  At least 5 years Call Center Management experience preferred. Experience with application of healthcare criteria systems and programs, e.g. Triage, InterQual, Milliman, or Behavioral criteria. Must have previous experience with URAC and or NCQA accreditation  process. Call Center knowledge desirable    
 
Knowledge/skills:       
·        Ability to develop and execute product plans, including identification of resources and budget required;
·        Excellent communication skills, both verbal and written;
·        Ability to direct and coordinate programs, projects, resources, and staff across multiple company functions;
·        Strong administrative qualities to analyze goals, products, programs, and processes and make recommendations for changes;
·        Knowledge of all aspects of the following managed care products: utilization management, case management, disease management, and triage;
·        Organizational and project management skills;
·        Experience working with clinical documentation programs designed for case management, disease management, utilization management and triage programs;
·        Strong computer skills and experience with Microsoft Office;
·        Ability to manage all inbound and outbound call center functions to meet established productivity, performance, and quality standards.
·        Strong communication, interpersonal and leadership skills.
ACCOUNTABILITIES:

Job Performance/Responsibilities

Coordinates and directs all Medical Utilization Management, Case Management, and Nurse Triage programs.
·        Assure job descriptions and staff roles/responsibilities are accurate and current;
·        Responsible for supervision and oversight of staff
·        Supervise the interviewing and hiring of staff and supervisors for the above programs;
·        Assist in the licensing and accreditation process for all programs;
·        Assure that all regulatory and accreditation standards are implemented and met;
·        Assure that Policies & Procedures, Operational Guidelines, and process workflows are current meet quality accreditation and regulatory standards, and are communicated to and available for staff on the IntraNet;
·        Develop annual Workplan & Evaluation for each program in conjunction with the QI committee (includes goals, objectives, and planned new processes/enhancements) and communicates the Annual Workplan and previous year’s Summary to Senior Management and staff;
·        Assist the Quality department in the development and evaluation of an annual QI plan for all programs and assures all indicators are met;
·        Participate in the Quality Committee and assists in related functions;
·        Analyze all programs to ensure effectiveness, quality, productivity, profitability and patient safety;
·        Coordinate all programs and work with other Health Integrated Departments and Committees, i.e. Quality Committee, Education, Account Management, etc;
·        Assist in new product development efforts and assures current products are being delivered as designed;
·        Assist the Senior Vice-President of Clinical Operations in plans for growth;
·        Provide input and direction to Information Services on systems issues and enhancements;
·        Offer input and assist with development of orientation, education and training programs;
·        Assure delivery expectations of client contracts are being met; 
·        Assist in the development of management reporting capabilities and works with supervisors to ensure they understand and use them to effectively manage the delivery of services; and
·        Provide required reports and special projects as needed.
·        Ensure clinical staff consult and seek advise from a licensed physician with expertise appropriate to the types of services being managed
            Customer Services-Internal:
·        Work with supervisors and staff to develop a high level of morale, positiveness, and commitment in the work environment;
·        Provide strong leadership role model for supervisors and staff;
·        Identify problems, issues and/or concerns proactively or as they arise and resolves them as quickly as possible;  
·        Develop strong working relationships with all internal staff members to encourage a cooperative sharing of ideas and support;
·        Monitor and report any quality of care issues or concerns to Quality Mgmt;
·        Maintain a courteous and professional attitude when working with all staff members and the management team;
·        Ensures that licensed health professionals are readily available to answer non-clinical staff questions and shall ensure that non-clinical staff are performing within the scope of the non-clinical role;

Customer Service-External:

·        Work, communicate and collaborate in harmony and in a courteous and professional manner with members, practitioners, providers, multidisciplinary health care team members, and clients;
·        Work collaboratively with the health plan’s management team to assure quality service delivery that meets client expectations; and
·        Serve as a liaison and patient advocate, when applicable, for quality of care and cost outcomes.
 

Example job description



JOB DESCRIPTION:

The President & Chief Executive Officer is responsible for the overall direction and administration of programs and services provided by the health plan. Implement programs that are in alignment with Company strategic plan.

This seasoned executive will provide day-to-day leadership and management of the health plan that mirrors the company's mission, vision, and core values. Oversee programs and service areas of the health plan through supervision of management staff. Ensure that the overall level of quality for delivery of medical services meet or exceed appropriate standards. Ensure fiscal well-being of the health plan.

Required:
•10-plus years progressive healthcare experience in managed care industry; preferably with exposure to Medicaid products
•5-plus years management-level experience.
•Bachelor’s Degree in Health or Business or related discipline
•Strong presentation skills (verbal and written).
•Project management.
•Financial modeling.
•Business development and implementation.

Preferred:
•Previous NCQA experience working with NCQA standards.
•Knowledge of managed care culture and philosophy, plus Medicaid billing practices.
•Strong analytical and reasoning abilities.
•Experience and knowledge of regional area of operations.
•Master's Degree in healthcare-related field.

Example job description


Job Description

POSITION PURPOSE:
To direct Medical Services activities related to Government Programs, including but not limited to: CMS, Federal Employees Program, and Medicaid.  Oversee utilization and quality management activities including support of collaborative relationships with physicians and hospitals to achieve mutually acceptable business goals. 
MINIMUM POSITION REQUIREMENTS:
Required Experience:
·        Five years of clinical practice
·        Two years health plan managed care (either with a medical group or health plan) utilization management, health care quality improvement (such as NCQA, CMS), and in the development and implementation of clinical practice guidelines
Required Education:
·        Doctorate Degree in Medicine
Required Certifications/Licenses: 
·        Current, unrestricted medical license – either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
Required Knowledge, Skills and Abilities (KSAs):
Knowledge of:
·        Knowledge of Continuous Quality Improvement theory and practice
·        Healthcare financing and the relation to various products (HMO, PPO, Indemnity, and Medicare Advantage) and the health care delivery system
Skills:
·        Planning and decision-making skills. 
·        Leadership skills
·        Basic computer skills (including Microsoft Word and Excel)

PREFERRED QUALIFICATIONS:
·        Knowledge of data management and information systems
·        Board certification by an ABMS recognized specialty board
·        Experience with Disease Management, Quality Management, and Pharmacy Management
PRIMARY ACCOUNTABILITIES: 
1.     Direct medical management utilization activities, Disease Management and Quality Management programs as necessary to maintain compliance with government programs, including but not limited to CMS, FEP, Medicaid, and other accrediting bodies for which there is a business need.
2.     Provide medical expertise and collaboration for all Disease Management, Quality, Pharmacy, Care Management, and Medical Review initiatives.
3.     Support collaborative relationships with physicians and hospitals.
4.     Evaluate and modify medical decision-making policies and review criteria as appropriate.
5.     Participate in Medical Management strategic planning in evaluating utilization, quality, national and local trends, and identify interventions to optimize the utilization of resources and the delivery of high quality health care services.
6.     Participate in the Appeals and Grievance process to assure timely, accurate responses to members and providers.
7.     Provide written information to members and providers through letters, articles and editorials in various BCI publications.
8.     Create strategic opportunities to control cost and increase quality. 
9.     Work to assure productive relationships with all customers, employers, members, and providers to assure that members receive appropriate health care in the most appropriate setting with the best value in health care. 
10.  Work collaboratively with Actuarial, Marketing, Provider Services, and Claims to assure optimal customer service while assuring contract defined resource management. 
11.  Work closely with other Medical Directors, Director of Medical Quality Management, Director of Pharmacy, Medical Directors of Physician Networks and all other departments and divisions

SECONDARY ACCOUNTABILITIES:
1.     This position may serve as a member or chair the following committees:
§  Quality Management Committee
§  Credentialing Committee
§  Medical/Quality Management Leadership Committee
§  Pharmacy and Therapeutic Committee
§  Physician Advisory Panel
§  Other committees, public and internal, as assigned
2.     Perform other duties as deemed necessary by the Sr. Medical Director and/or Sr.VP/Chief Medical Officer.

Example job description



 POSITION DESCRIPTION

POSITION MISSION:
To plan, direct and assure implementation of the Provider Services activities with practitioners, new healthplans, initiatives, protocols and products, which ensure compliance with contract criteria.

JOB FUNCTIONS:
1)     Set business strategy for Provider Services that reflects the overall goals and objectives of HCP.
2)     Maintain ongoing relationships with all levels of the organization to detect provider issues and implement corrections.
3)     Identify systems issues and work jointly with all departments at HCP to assure services provided to the network meet the stated expectations.
4)     Plan and direct the writing and presentation of internal and external communications and ensure that all aspects are compliant with applicable contract(s).*
5)     Develop and direct communication plans with other departments, educate, through in-services, both internal departments and outside providers to ensure that the overall corporate Provider services objectives are achieved, and network-wide problems are minimized.*
6)     Initiate the growth and development of medical groups and IPA’s as dictated by business needs and enrollment growth opportunities.
7)     Develop and direct distribution of fast faxes, provider manual and other written documents to the providers within the network.*
8)     Develop target provider list for inclusion in Affinity I and II.  Ensure adequacy and cost containment for Professional Services.
9)     Facilitate the initiation of strong, positive working relationships with physicians and their office staffs.*
10) Direct Provider Services aspects of new contracts for healthplans. 
11) Direct research and make recommendations for benefits to be paid in capitated and fee for service networks.
12) Direct, manage, implement and follow through on new projects as needed. 

*Essential Job Functions

POSITION DESCRIPTION

QUALIFICATION REQUIREMENTS:
Skills, Knowledge, Abilities:
·        Strong organizational and problem solving skills with bottom-line orientation.
·        Knowledge of market and industry standards as well as contract and cost management.
·        Excellent written and oral communication skills and the ability to interact with internal and external customers and vendors.
·        Proven ability to coordinate the activities of a multidisciplinary team, and to handle multiple assignments simultaneously.
·       Demonstrated superior people, and customer relation’s skills to interact with physicians, and their office staffs to maintain high satisfaction.
·       Demonstrated expertise to produce results within a budget and an aggressive time frame.
·        Demonstrated self-directed results-oriented approach to projects and responsibilities in an unstructured, cutting edge, fast-paced environment.
·        Strong knowledge of MS Excel, Access and Word necessary; Powerpoint is a plus.
Training/Education:
·       Masters degree or equivalent of in healthcare, business administration or related field preferred but not required. Knowledge of medical practice Services is a plus.
·        Higher degree preferred.
Experience:
Min. 3 years senior level health care related experience with emphasis on Provider Services and Contracting, Physician Profiling, Database manipulation and reporting, Network formulation and Design.  The ideal candidate also has experience in an HMO, IPA, medical group, physician management company, other managed organization or consulting firm with responsibilities for network development, physician recruitment, physician practice management, clinical duties, or combination.  An automobile required for travel locally.

POSITION REPORTS TO:
Vice President, Network Operations
POSITIONS SUPERVISED:
Provider Service Representatives
The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skill required of personnel so classified.

Example job description


     

Role:
The Vice President/ Corporate Compliance (VP/CC) is the Chief Compliance Officer for the Corporation and its subsidiaries. The Vice President is responsible for advising and making recommendations to the President/CEO and the Board of Directors about status of quality, safety and compliance with federal, state and local regulations.  S/he is responsible for the overall effectiveness of the Corporate Compliance Program and serves as the primary corporate resource for Medicare/Medicaid reimbursement information. The Vice President promotes awareness and understanding of ethical and moral principles consistent with the mission, vision, and values of the organization and those required by law.  The VP/CC has the authority to meet the responsibilities of the position and has direct access to legal counsel, the Hospice governing body and CEO/President.  The Vice President is also responsible for overseeing the functions of Performance Improvement, Employee Health and Safety, Infection Control and Health Information Management (Medical Records).
Qualifications:
•      Master's Degree in healthcare, business or law
•      10 years experience in the compliance field
•       5 years management experience at an executive level
•      Certified Compliance Officer
•      Risk Manager a plus
•      Ability to manage and develop staff
•      Demonstrated commitment to working as part of a team
•      Broad knowledge of the Medicare program, the managed care industry, Sarbanes Oxley, and other    
        pertinent regulations and legislation.
•      Experience in safety and disaster management, medical-legal issues; performance improvement
       methodologies and statistical tools.
•      Strong verbal and written communication, problem solving, change management, and diplomacy skills.
•      Computer skills: windows based applications, spreadsheets, presentation software
•      Confidential and professional in manner and action
Competencies:
•       Satisfactorily complete competency requirements for this position.
General Responsibilities:
•       Represent the organization professionally through care delivered and/or services provided to all clients.
•       Comply with all state, federal and local government regulations; maintain a strong position against fraud and
        abuse.      
•       Comply with all policies, procedures and standard practices.
•       Observe all health, safety and security practices.
•       Maintain the confidentiality of patients, families, colleagues and other sensitive situations.
•       Use resources in a fiscally responsible manner.
•       Promote the organization through participation in community and professional organizations.
•       Participate proactively in improving performance at the organizational, departmental and individual levels.
•       Improve own professional knowledge and skill level.
•       Advance electronic media skills.
•       Support the organization’s research and educational activities.
•       Share expertise with co-workers both formally and informally.
Leadership Success Factors:
•      Communication.  Express thoughts and ideas clearly.  Adapt communication style to fit audience.
•      Initiative.  Originate action to achieve goals.
•      Management Identification.  Identify with the problems and responsibilities of management.
•      Judgment.  Make realistic decisions in consideration of organizational resources.
           
•      Planning, Organizing and Controlling.  Establish course of action for self and others to accomplish a specific goal;         plan proper assignments of personnel and appropriate allocation of resources. Monitor results.
•      Leadership.  Use appropriate interpersonal styles and methods in guiding others toward task accomplishment.
•      Work Standards.  Set high goals or standards of performance for self and others.  Compel others to perform.
•      Tolerance for Stress. Maintain stability of performance under pressure and/or opposition.
•      Innovativeness.  Generate and/or recognize imaginative, creative solutions in work related situations.
•      Delegation.  Allocate decision making and other responsibilities effectively and appropriately.
•      Staff Development.  Develop the skills & competencies of subordinates.
•      Organizational Sensitivity.  Perceive impact and implications of decisions on components of the organization.
•      Ethics. Model highest standards of conduct and ethical behavior.
•      Regulatory Compliance: Educate and monitor staff regarding their own and the organization's responsibilities
        for regulatory compliance.
Job Responsibilities:
Administration                                                              
•      Responsible for the leadership, recruitment and retention of Compliance, Performance Improvement, Health &
       Safety, and Health Information Services staff.
•     Conduct timely performance evaluations.
•     Ensure staff attendance at requisite education programs.  
•     Lead the strategic planning and implementation process in all areas of responsibility.
•     Develop policies and procedures for all areas of responsibility.
•     Participate in committees and projects as required.
•     Maintain system of reporting to the governing board, CEO and Corporate Compliance Committee.
•     Coordinate personnel issues with Human Resources.            
•     Ensure independent contractors and agents are aware of requirements of billing, marketing etc.  Assist    
      financial management in coordinating internal annual/periodic departmental reviews.
•     Review contracts that may contain referral and payment issues which might violate anti-kickback statute or
      physician self-referral prohibition or other regulatory requirements.
•     Direct processes for medical record form’s approval and administrative policy and procedure review.
Budget Development and Control
•    Develop/oversee the development of departmental budgets
•    Monitor and control budgets to ensure all guidelines are met and cost effectiveness is maintained.
Corporate Compliance
•   Develop and implement a system-wide program to ensure compliance with applicable federal and state laws and
     regulations.  Periodically revise program to reflect changes in organizational need, governmental policies &
     procedures, and third party payers. 
•   Direct system-wide audits to investigate and monitor organizational regulatory compliance.
•   Develop policies and procedures for the general operation of the Compliance Program and related activities to    
    reduce vulnerability to misconduct.
•   Maintain current AHCA, CLIA, Biomedical and Occupational licenses.  
•   Chair the Corporate Compliance Committee.
•   Review complaints, concerns, questions, or corrective actions relative to compliance issues in all departments, or
    with regulatory agencies. 
•   Make recommendations for the reporting of suspected fraud and other improprieties. 
•   Manage the Compliance Hotlines and responds to reports.
•   Collaborate with other departments, General Counsel, fiscal intermediaries, state and federal regulatory agencies
     to address issues or concerns.
•    Keep abreast of changes by regulatory agencies and community/national standards as they relate to Hospice and
     communicate them to the management team. 
Risk Management
•    Implement and maintain a proactive Risk Management Program which identifies, implements and recommends
     actions to reduce potential risks and promote the quality of hospice care and services.
•    Coordinate depositions from staff with legal counsel.
•    Interface with legal counsel appointed by the organization’s liability carriers.
•    Advise Interdisciplinary Team members on risk issues.
Staff Development/Education                             
•    Provide or coordinate orientation, education and training relevant to regulatory compliance, safety, disaster, infection
     control, accreditation standards, HIPAA standards, and Performance Improvement.
•    Provide for Performance Improvement education to all levels of staff. 
•    Identify educational opportunities for department staff to increase expertise and value to the organization.
•    Provide regular performance feedback and guidance to department staff.
Professional Self-Development               
•    Enhance professional expertise, management competency and leadership skills through education and training.
Other
•   Coordinate JCAHO, AHCA and Medicare Surveys.
•   Perform other duties as requested by President/CEO.