Director of Compliance Clinical Quality and Digital Technology

With a legacy that spans over 150 years, Bon Secours is a network that is dedicated to providing excellent care through exceptional people. At every level, everyone on our teams have embraced the call to provide compassionate care. Here, you can work with others who share common values, and use your skills to help extend care to all of our communities.

DIRECTOR OF COMPLIANCE CLINICAL QUALITY AND DIGITAL TECHNOLOGY | Work from Home - Nationwide

WFH role with ~10% travel - onsite to hospitals, ministry-wide

Primary Function/General Purpose Of Position

Under the direct supervision of the System Director, Compliance, this position contributes to the Bon Secours Mercy Health mission and vision by developing and implementing the compliance workplan for clinical quality programs, patient safety and digital technology. This position oversees and provides compliance related activities relative to Bon Secours Mercy Health operations conducted at local and remote locations and leads adhoc compliance investigations, education, auditing and monitoring.

Essential Job Functions

• Implement the BSMH Compliance program within clinical quality, patient safety and digital technologies, including application of leading practice approaches to identification, assessment, and mitigation of risks, auditing and monitoring, workplan development, education of operational leaders on laws and regulations, establishing functional compliance committee, and implementing compliance policies
• Serve as the subject matter expert on clinical quality, and patient safety by staying up-to-date with applicable laws, regulations and certifying bodies including CMS, TJC, NCQA, NIST, OIG, FTC, OCR, FDA, ONC, State Medicaid and/or other relevant agencies
• Conduct audits and monitoring of medical records for quality/medical necessity, patient safety events and digital technology application integrity, evaluating their compliance with relevant regulations, industry standards, clinical guidelines, internal policies, and provide recommendations for improvement
• Provide advice/consultation to functional leadership regarding clinical quality, patient safety and digital technology initiatives to assist in mitigating risks to the organization. This will include education and training sessions on emerging risk areas, policy & procedure development, governance, and risk frameworks
• Lead advanced investigations across the ministry relative to medical necessity, clinical quality, patient safety and digital technology integrity. Works collaboratively with IT, Quality, Patient Safety, Medical Group, Cybersecurity, Patient Experience, Legal, and other BSMH Partners to conduct interviews, document investigatory steps, and makes corrective action recommendations
• Develops monitoring and auditing protocols/tools specific to clinical quality, patient safety and digital technology.
• Identify and implement artificial intelligence applications that provide data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third-party vendors to detect, monitor, and audit potential compliance issues
• Participates in various ad-hoc and/or established BSMH committees to provide updates and perspective, and shares identified risks with Compliance Leaders for awareness and collaboration.
• Identifies the need and develops educational content and trending of non-compliant activities to enhance proficiency and competency, understanding of standards and the consequences of non-compliance. Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities.
• Hire, train, coach, counsel, manage and evaluate performance of direct reports within clinical quality, patient safety and digital technology areas
  
  

Licensing/Certification

Registered Nurse license in compact state or compact license (required)

Certified Professional in Healthcare Quality (preferred)

Certification in Infection Control (preferred)

HITRUST Certified CSF Practitioner (preferred)

Certified Information Systems Security Professional (preferred)

Registered Health Information Administrator (preferred)

Certified Artificial Intelligence Governance Professional (preferred)

Certified in Healthcare Compliance (preferred – must be obtained within 1 year of hire)

Certified Professional Medical Auditor (preferred)

Education

Bachelor of Science Nursing (required)

Bachelor of Computer Science (preferred)

Bachelor of Cybersecurity (preferred)

Bachelor of Health Information Management (preferred)

Bachelor of Science in Health Informatics (preferred)

Master in healthcare administration or informatics, nursing computer science, law, business or related field (preferred)

Juris Doctor (preferred)

Work Experience

7-10 years of in-depth experience in a combination of nursing clinical experience, medical necessity/utilization review, healthcare operations, clinical quality, artificial intelligence, and/or compliance related activities (required)

3-5 years of clinical experience in direct patient care acute or outpatient setting (required)

3-5 years of recent medical necessity and/or utilization review (required)

3-5 Year Of Management Experience (required)

3-5 years of experience with CMS quality reporting and value-based programs & initiatives (preferred)

1-5 years of experience in cybersecurity and technologies such artificial intelligence machine learning frameworks, and data integrity (preferred)

1-5 years of experience managing corporate compliance, or risk (preferred)

Training

EPIC Electronic Health Record (preferred)

CMS Quality Reporting and Value-Based Programs & Initiatives (preferred)

ECQM, CQM, and risk adjustment (preferred)

Adverse safety event reporting, Quality and Patient Safety Federal Act and regulations (preferred)

Accredited AI Governance & Compliance Programs (preferred)

Skills

• Proficiency in EHR systems
• Proficient in Microsoft Office including SharePoint, Smartsheets, Outlook, PowerPoint, Excel and Word.
• Working knowledge of ICD-9, CPT, DSM, and HCPCS coding systems. Knowledge of claims processing, utilization review, case management, quality assurance, and risk management methodologies.
• Demonstrated ability to conduct and document medical necessity investigations, address violations, and track corrective actions.
• Strong knowledge of applicable federal, state and local laws, regulations and policies pertaining to health care compliance matters.
• Demonstrated ability to independently identify, analyze, and propose and move forward with solutions, and ability to problem solve to find answers and solutions while using sound judgment
• Demonstrated ability to manage multiple or competing priorities and cross functional teams
• Strong analytical skills with the ability to interpret and present data effectively.
• Experience with interpreting state and federal requirements applicable to the organization, assessing their impact and making recommendations to operational stakeholders to ensure compliance.
• Excellent analytic and problem-solving skills to report, identify compliance risks and prioritize recommendations.
• A leader who will inspire confidence with key stakeholders, build consensus, influence others, maintain credibility and effectively lead teams
• Demonstrated ability to collaborate effectively with cross-functional teams, build relationships with key stakeholders, leaders, and influence others to achieve compliance objectives
• Excellent analytical, communication and critical thinking skills with intuitive ability to appropriately escalate matters based on potential risk to the organization.
• Ability to develop unique and novel solutions to problems; view change as necessary.
• Responds well under pressure; accepts delegation while simultaneously serving as a coach/mentor/supporter to subordinates
• Robust organizational skills with an attention to deadlines, details, and accountability
• High degree of integrity and ability to maintain confidentiality
• Willing to learn, admit to mistakes and have an open mindset to new avenues of problem-solving.
  
  

Many of our opportunities reward* your hard work with:

Comprehensive, affordable medical, dental and vision plans

Prescription drug coverage

Flexible spending accounts

Life insurance w/AD&D

Employer contributions to retirement savings plan when eligible

Paid time off

Educational Assistance

And much more

• Benefits offerings vary according to employment status
  
  

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com