PRIMARY FUNCTION: The Vice President, Compliance & Risk Management will lead Pediatric Associates’ compliance, privacy and risk functions, creating a strong culture of compliance focused on development and implementation of enterprise-wide compliance, privacy, and risk processes across all service lines.
The Vice President, Compliance & Risk Management will be responsible for constructing a company-wide program that creates a consistent, scalable compliance and risk mitigation effort. A key objective will be to drive a centralized program across all service lines and functions of compliance and risk including: policies, procedures, training; audit and investigations; acquisition diligence and analysis; and execution of risk-based controls that support Pediatric Associates’ operations.
The successful candidate will have the opportunity to make an immediate contribution to Pediatric Associates’ continuing growth and success. We are seeking a proven strategic and tactical leader who is motivated, smart, and a self-starter. S/he will need to be decisive and demonstrate the ability to execute significant initiatives. S/he must present with credibility and confidence with an ability to lead the charge. S/he will be a "hands-on" compliance and risk expert who is able to run autonomously yet operate in a complex and multi-line business.
REPORTS TO: Reports to the Chief Executive Officer, with a dotted line to the Board.
SUPERVISORY RESPONSIBILITIES: This role will oversee the Director of Clinical Risk Management and the Director of Compliance and Privacy, and all operational functions associated with these areas. In addition, he/she will need to have skills to matrix manage through influence (not direct authority) to guide risk and compliance efforts.
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
COMPLIANCE & PRIVACY:
- Act as a champion for Pediatric Associates’ Compliance & Privacy Program.
- Develop, implement and oversee a comprehensive healthcare compliance and privacy program across all service lines with a strong framework and operating model for all of Pediatric Associates’ medical clinics.
- Partner with various medical and business teams to identify and address potential compliance or privacy issues and proactively design solutions to meet the needs of the business, as well as the expectations of regulators.
- Lead investigations and respond to alleged violations of compliance and privacy matters in coordination and collaboration with medical and business functions and, when necessary, legal counsel.
- Advise the Company’s business leaders on appropriate compliance and privacy internal controls.
- Maintain expertise in regulatory compliance and privacy matters, with an emphasis on implementing an optimal compliance and privacy program, mitigating risk, conducting internal investigations, complying with evolving laws, regulations, guidance and directives impacting Pediatric Associates.
- Develop, implement and oversee healthcare compliance and privacy training and communications strategies, plans, content and associated materials. Develop metrics to determine effectiveness of training program.
- Proactively identify potential areas of compliance vulnerability and risk; develop/implement corrective action plans for resolution of problematic issues, and provide general guidance on how to avoid or deal with similar situations in the future.
- Provide coaching and compliance guidance, as needed or otherwise appropriate, to various internal partners and stakeholders.
- Conduct routine and ad hoc healthcare compliance and privacy compliance audits and monitoring of functional processes across Pediatric Associates to ensure adherence to healthcare compliance and privacy policies, procedures and guidelines.
- Communicate and interact with all levels of employees and management as a mentor and a resource with respect to compliance and privacy issues.
- Communicate with external stakeholders to support the Company’s compliance and privacy programs.
- Provide reports on a regular basis and assist, as requested, in communication with senior management and the Board of Directors regarding the operation and progress of compliance efforts.
- Ensure proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
- Understand and be able to translate into "plain English" the compliance ramifications of varied issues and regulatory requirements, and clearly and succinctly articulate the risks. Provide valuable advice and counsel within the context of the broader business and enterprise level objectives.
CLINICAL RISK MANAGEMENT:
- Develop, implement and oversee operations of the clinical Risk Management program including enterprise-wide systems for risk identification, investigation, and reduction across all service lines.
- Develop, initiate, maintain, and revise policies and procedures for the general operation of the clinical Risk Management program to assess, mitigate and manage risks to the organization across all service lines.
- Provide reports on a regular basis, and as directed or requested, to inform the Board and management of the operation and progress of clinical Risk Management efforts.
- Develop and supervise clinical risk identification/prevention strategies through training, problem identification, and data analysis related to patient and employee injuries including aggregate data summaries, trend analyses of incidents, claims profiles; provides aggregate analysis of risk data; maintains statistical trending of losses and other risk management data.
- Serve as a resource for issues that arise concerning environmental safety, infection control, patient safety, and risk management. Develop, implement and oversee safety and emergency preparedness/response functions of organization.
- Develop, implement and oversee patient safety program including occurrence reporting, follow and root cause analysis.
- Under the direction of counsel, manage professional liability claims. Participates in evaluation of claims for settlement within administrative authority; negotiates settlement of small claims within administrative authority.
- Proactively assess and improve patient safety and medical errors processes. Act as a resource, internal consultant, and educator for patient safety/risk management
- Perform other duties as assigned or requested.
TYPICAL WORKING CONDITIONS: Working in a professional office environment. Temporarily a remote position as we take safety precautions against Covid-19. The position involves high & frequent call volumes. Environment requires ability to multi-task, communicate clearly & concise, data entry for extended period of times. May require sitting or standing for long periods, including stooping, bending & stretching for files and supplies. Requires, occasional lifting of files and boxes weighing up to 50 pounds. Requires manual dexterity sufficient to operate a keyboard, type at 35 wpm, operate calculator, copier, and such other office equipment as necessary.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
EDUCATION: Bachelor’s degree required. Juris Doctor, Master’s degree in Business, Healthcare Administration, or equivalent degree is preferred.
LICENSURE/CERTIFICATION: Certification in Healthcare Compliance (CHC, CHC-F, CHRC and/or CCEP) is highly desirable and encouraged to complete within the first year of employment.
EXPERIENCE: A minimum of 10 years in a compliance/privacy/risk role within the healthcare industry with 7+ years in a leadership position.
KNOWLEDGE, SKILLS & ABILITIES: The ideal candidate will have a demonstrated, successful track record of leading a corporate compliance, privacy and risk programs within the healthcare industry. S/he will be a clear champion of best practices and can bring Pediatric Associates a fresh approach and insights to enhancing its current compliance, privacy and risk programs.
- A proven compliance and risk leader with experience developing and managing the infrastructure of compliance and risk programs within an organization. Demonstrated ability to build, mentor and lead.
- Experience as a member of a senior management team, adding value and input at both the executive team and Board level. An ability to clearly and concisely communicate the Company’s compliance and risk plan and approach, both internally and externally.
- Highly strategic with excellent judgment. Ability to the see the "big picture" as well as very detailed and specific business issues and integrate compliance, privacy and risk with business goals, so as to partner effectively with business leaders.
- Experience in positively and successfully managing relationships with a high energy, diverse group of medical and business leaders.
- High degree of organization and efficiency with demonstrated attention to detail.
- Superior written and verbal communication skills (including presentations).
- Team player who drives for practical business solutions.
- Flexible and responsive to meet business needs and issues as they arise.
- Able to roll up sleeves and do what is needed to get the job done.
- Entrepreneurial with a drive for excellence, dedicated, hardworking, enthusiastic and energetic.
- Shares a sense of urgency and possess the drive required for Pediatric Associates to continue to grow and succeed.