The overall purpose of the Director of Risk Management and Quality Improvement position is implementation of a comprehensive Risk Management program encompassing orientation and continuing education guidelines, safety awareness program, evaluation of Resident quality of care to include audit of clinical documents and subsequent synopsis of care rendered (protected by attorney-client privilege), conduct in-services and continuing education seminars, provide investigative support for Compliance calls (protected by attorney-client privilege and works directly with General Counsel), management of HIPAA Compliance Program, RTA and QIPP.
- A current and valid Texas-specific RN license is required.
- Legal Nurse Consultant Certification is required
- Must have knowledge of and ability to implement Risk Management and Safety Awareness Programs for both resident and employee populations.
- Ability to travel to facilities and provide a hands on teaching approach.
- Ability to manage all forms of communications. Ability to read, write, and speak the English Language.
- Develops, implements, and manages a Risk Management Program that identifies resident and/or employee population risk areas for the Company.
- Involved in chart audits for benefit of reviewing care rendered and outcomes achieved for certain reportable and general areas of concern, e. family complaints, trend concerns, etc. Provides verbal and written report to General Counsel and is protected under “Attorney-Client” privilege
- Conducts routine site visits to evaluate key risk areas for a Facility, Agency or Business unit, collects data, samples a resident population with identified areas of concern, provide verbal and written recommendations, and schedule follow-up visits to ensure risk areas have been addressed. Provides written feedback to General Counsel under “attorney-client” privilege.
- Conducts on-site investigation of any grievances/complaints filed through the Company Quality Hot-Line. Will initiate report, initiate interviews, and provide feedback and recommendations to General Counsel and Compliance Officer. This function is protected under “Attorney-Client” privilege and requires a high degree of professionalism, discreetness, and neutrality
- Oversees, directs, and ensures a Quality Assurance Program is followed by each Community and provides an executive summary at Quarterly Quality Assurance meetings about Community-specific compliance with Quality Assurance, Safety Awareness, Employee Medical Claims history, as well as Risk Management review of key systems that triggered during initial site visit
- Oversees, directs and ensures facilities attain the highest compliance possible while participating in the QIPP (Quality Incentive Performance Program).
- Collaborate with Director of Care Transition, Regional Clinical Teams and facility leadership to maintain an acceptable Return to Acute that is better than State and National thresholds allowing for the full 2% in CMS Valued Based Program.
- Periodically updates and informs Clinical Department of Provider Letters issued from TDHS; issues provider letter updates under general memorandum and/or Cantex Update Letters
- Ensures Community staff complete and send to all necessary agencies including Home Office critical documents necessary for timely filing, i.e. OSHA related reports (needle stick injuries, OSHA 300 Log compliance)
- Coordinates with Employee Claims Manager to provide Community-specific safety awareness training where claims are present and safety issues identified
- Assists Employee Claims Manager to determine clinical approach best to allow employee to return to work post injury
We are an Equal opportunity employer; We offer an excellent benefit plan to include 401K with match, CEU reimbursement, vacation, sick, holidays, medical, dental, and supplemental insurance Plans as well as a Highly competitive compensation package.