HealthRIGHT 360 gives hope, builds health, and changes lives for people in need by providing comprehensive, integrated, compassionate care that includes primary medical care, mental health services, and substance use disorder treatment.

QUALIFICATIONS

Education, Experience, and Credentials

• Bachelor’s degree or higher in health services, public health, business, or a related field.
• A minimum of 4+ years of experience in healthcare compliance, quality assurance, or regulatory affairs role.
• Prior experience leading or coordinating responses to external audits, investigations, or corrective action plans is highly desired.
• Experience performing root cause analyses and using data-driven techniques to recommend solutions.

Knowledge, Skills and Abilities

• Extensive knowledge of healthcare laws and regulations at the state and federal level (e.g., licensing requirements, privacy laws such as HIPAA, Medicaid/Medicare rules, and other applicable standards).
• Demonstrated ability to interpret complex regulatory requirements and apply them to organizational policies and practices.
• Advanced analytical and problem-solving skills.
• Proficient in analyzing large data sets, audit results, and incident trends to draw meaningful conclusions.
• Strong project management and organizational skills.
• Able to manage multiple complex assignments or projects simultaneously – for example, coordinating an agency-wide audit response while also handling ongoing incident reviews. Consistently meets deadlines and delivers thorough, high-quality work.

We will consider for employment qualified applicants with arrest and conviction records

• Complex Case Investigation: With direction from the MDCO and others on the Compliance leadership team as well as agency partners, such as Human Resources, conduct detailed investigations into significant compliance issues, incidents, or breaches. Gather and evaluate information from multiple sources (e.g., EHR data, interviews, incident reports) to determine root causes of problems. Document findings and recommendations clearly for internal review and action.
• Corrective Action Planning and Monitoring: In collaboration with Compliance leadership, develop and drive the implementation of corrective action plans (CAPs) in response to compliance findings (such as audit deficiencies or recurring incidents). Coordinate with relevant departments to craft effective solutions that address underlying reasons for the issues, and follow up to ensure actions are completed and effective. Monitor to completion CAP items in partnership with programs and Compliance leadership.
• Audit and Regulatory Support: Take a lead role in preparing for and facilitating external audits, reviews, or accreditation surveys. Act as a subject matter expert during audits in areas of compliance expertise, responding to complex inquiries from auditors or regulators. Assist the MDCO in coordinating agency-wide responses to audit results and in drafting official communications or reports post-audit.
• Collaboration with Leadership: Work closely with the Compliance Manager and MDCO to identify compliance risk areas and develop strategies to mitigate them. Collaborate with program directors and upper management to implement compliance initiatives and improve practices, ensuring that solutions are practical and effective for program operations.
• Root Cause Analysis: Utilize structured methodologies to conduct root cause analysis of recurring compliance problems or significant incidents (for example, repeated documentation errors or serious client safety events). Produce comprehensive reports that outline contributing factors and recommend process or policy changes to prevent future occurrences.
• Mentorship and Training: Provide guidance and mentorship to Compliance Analyst I staff, especially on complex cases or data analysis techniques. Lead by example in sharing best practices for compliance work. Develop and deliver specialized compliance training or briefings for staff and management on advanced topics as needed.
• Policy Development Support: Assist compliance leadership in identifying policy creation, modification or updates, reviewing and updating compliance policies, procedures, and workflow documentation. Offer insights based on front-line experience regarding improvements or clarifications needed in policies to enhance compliance effectiveness.
• Medical Records Retrieval: Provides support in processing Medical Records for general requests, subpoenas, court orders or similar requests as vetted and directed by Compliance management.
  And, other duties as assigned.