Quality/Risk Manager (RN), Medical Group Services

Description: Clinch Valley Health
Who We Are:
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Clinch Valley Medical Center is a 175-bed acute care hospital with a growing integrated network of care that offers many services for our community. Today, our unwavering commitment to our patients ranks us as one of the top hospitals in Virginia and the nation for quality of care - including patient safety and health outcomes.
Where We Are:
As one of the most peaceful towns in the State of Virginia, Richlands is comfortably located within the mountains of Southwest Virginia. Nestled in the Appalachian Mountains and along the banks of the Clinch River, the Town of Richlands is privileged by the exposure of a diverse and unique culture. Many of the local attractions reflect the unique culture of Appalachian Mountains.
Why Choose Us:

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off / Extended Illness Bank package for full-time employees
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants
• Employee discount program
• And much more€

Position Summary:
Collaborates with Operations Clinical Leadership Teams, quality staff, and healthcare delivery teams, to implement, monitor, and evaluate the organizations healthcare quality and safety programs, to improve patient outcomes. Performs a variety of duties related to analysis and evaluation, which includes creating and implementing policies, systems and processes, that improve patient care and safety. Serves as a resource for clinical leadership and staff, for risk and quality related issues and information. Ensures, that the offices are in compliance with ever-changing legislation and safety regulations. Is a liaison to the Risk Manager/Coordinator, facilities legal team and out-side agencies to mitigate and manage risk. Plans, develops and administers records management policies, designed to facilitate effective and efficient handling of health information records.
Essential Functions:
• Develops and maintains clinic policies, forms and procedures.
• Works with the Operations Team to create, update and maintain provider manuals.
• Educates staff on risk awareness and prevention, confidentiality and appropriate documentation
• Understands and follows safety and security procedures. Personally practices preventative safety procedures.
• Immediately reports all accidents and incidents to the Operations Team or Human Resources
• In conjunction with operations, legal and the risk management, mediates patient and employee complaints and investigations
• Coordinates Quarterly Rural Health Audits and compliance for accreditation. Coordinates annual review with facility medical director and annual meeting.
• Maintains records for RHC State Surveyor: Policies; Staff Licensure and Credentials.
• Coordinates Risk case review, in conjunction with the Operations Team, when applicable.
• Notifies Operations Team, Risk Manager and the companies Legal Counsel of potential litigation or malpractice claims.
• Reviews medical records for liability issues
• May be asked to research records and report, on instances of fraud or theft
• In coordination with the Operations Team, may be asked to conduct on-going patient satisfaction surveys
• In conjunction with the Operations Team, provides quality data as available to Senior Management.
• Provides data for analysis, in the development of risk management plans and strategies, to enhance overall programs and identify areas of quality improvement
• Participates in provider education, in regards to quality and healthcare reform
• Coordinates Quality Measure efforts with the Lifepoint Quality Team
• Coordinates Quality Wellness Preventative Health
• Works closely with Clinical Nurse Manager with staffing, scheduling, and disciplinary actions for clinical staff. This position will serve as the backup to the Clinical Nurse Manager.
• Works closely with Clinical Nurse Manager to keep offices functioning within state compliances and accreditations.
• Provides direct supervision of staff, including assignment of work tasks, coaching, training and general performance.
• Directs the health information management functions which include release of information, transcription, analysis, record imaging and electronic medical record technical support.
• Develops departmental goals and objectives within the health care delivery system
• Develops and enforces the organizations health information management policies and procedures including, but not limited to release of information, storage, retrieval and record retention
• Monitors health information management systems and sets the healthcare systems standards for data quality and ethical practice. Includes forms management, documentation standardization and record content management.
• Representative for facility as health information records custodian for legal purposes and court appearances.
• Acts as the Facilities Privacy Official "designee" and reports to the Market Director, Ethics & Compliance Officer, and the Privacy Officer. Works collaboratively with risk management, to minimize the potential risk of privacy and security breaches, to mitigate harm, if any and to resolve related issues.
• Initiates, facilitates and promotes activities, to foster information privacy and security awareness within the organization
• Educates staff on polices governing HIPAA and performs routine audits to ensure compliance
• Assist patients and representatives with HIPAA privacy complaints and request: Privacy or Security Breaches; Access to records; Amendment Request; Restrictions; Confidential Communications Request and Accounting of Disclosures.
• Reports breaches on the Corporate Portal
• Acts as facility Recovery Audit Coordinator. Ensures completion within the regulated time frame by CMS and the RAC reviewers. Coordinates all files, response letters and files appropriate appeals, necessary in collaboration with Case Management and the physicians.
• Recognizes accuracy and workflow problems and performs quality management studies and makes recommendations.
• Monitors local, and national health care delivery changes in legislation and accreditation standards, that affect health information management.
• Provides work schedules and maintains sufficient staffing
• In coordination with HR and the Operations Team, administers progressive discipline, including corrective actions, when necessary, to ensure high level of job performance
• Conducts formal performance appraisals and develops action plans for employee development under their direct supervision or as assigned
• Effectively recruits, screens and hires staff as needed
• Manages activities to include timekeeping, approval of time off request and reinforces organizational core values and behavioral expectations, through modeling, communication and coaching.
• ID, COVID point person, for testing and updates
• Compliance point person for Medical Group Services
• Follow up on all RL Solutions issues
• Point Person for students in the following programs: MA, nurses, FNP, and VCOM
• Maintain college affiliation updates
• Legal Liaison
• Update and maintain CLIA waivers for 10 locations
• HRSA Certification and maintain membership
• Handles the VISA process for all Medical Group Services.
Qualifications:
Education: Associate degree in nursing from an accredited college/university. Bachelor's degree strongly preferred.
Experience: At least five (5) years of progressive nursing experience required. Experience is quality/risk management is strongly preferred. Must have strong organizational, analytical and objective problem solving skills. Team oriented mentality with flexibility to accommodate a variety of circumstances, while maintaining ownership and accountability of goals.
License/Certifications: Current Virginia RN license. BLS is preferred.
Skills and Abilities:
Computer Skills: Moderate Computers Skills Frequent use of electronic mail, word processing, data entry, spreadsheets, graphics, etc. Ability to create, maintain and incorporate simple functions into documents, spreadsheets, databases, and presentations to support business objectives.
Communication: Complex Communication Frequently communicates complex information and interacts with management. Can present, resolve and address delicate situations. Can motivate and persuade others.
Decision Making: Department Specific Impact Decisions impact the management and operations within a department. May contribute to business and operational decisions that affect the department.
Nature of Problems: Varied Business Problems Problems are varied and complex, requiring analysis or interpretation of the situation. Problems are solved using knowledge and skills, general precedents and practices.
Independent Judgment: Functional Independent Judgment Provides and sets goals and priorities for functional area. May make recommendations for department policies, practices, and programs. Makes decisions for and/or resolves problems for others.
Planning/Organization: Project Management Handle multiple projects simultaneously including task delegation, project oversight, and resource allocation.