Director of Quality and Risk

Centerpoint Health; MIDDLETOWN (OH); On-site; USD 70,000 - 110,000; Full time

Job summary

An established industry player in healthcare is seeking an enthusiastic Director of Quality and Risk to enhance compliance and quality assurance initiatives. This pivotal role involves overseeing compliance plans, conducting audits, and maintaining regulatory standards to ensure patient safety and quality improvement. The ideal candidate will possess strong analytical and interpersonal skills, along with a solid understanding of healthcare regulations. Join a dedicated team committed to improving healthcare outcomes in Southwest Ohio, and take your career to the next level in a supportive environment that values professional growth.

Benefits

Health Insurance

Assistance Programs

Paid Time Off (PTO)

Retirement Plan

Qualifications

• Graduate of an accredited nursing program; BSN preferred.
• Minimum five years of utilization management or audit experience.

Responsibilities

• Oversee compliance plans and investigate compliance issues.
• Develop measurement tools for quality performance and conduct audits.

Skills

Compliance Management

Quality Improvement Programs

Interpersonal Skills

Organizational Skills

Analytical Skills

Communication Skills

Education

Bachelor of Science in Nursing (BSN)

Accredited Nursing Program

Tools

CPT Coding

HCPCS Coding

ICD-9 Coding

Medicare Billing

Medicaid Billing

Job description

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Centerpoint Health is a Federally Qualified Health Center serving Southwest Ohio. We are looking for an enthusiastic Director of Quality and Risk to join our team!

Job Responsibilities:

1. Oversee developing, implementing, and enforcing compliance plans and investigate compliance issues.
2. Develop measurement tools for quality performance and conduct audits to ensure compliance.
3. Maintain knowledge of documentation guidelines; utilize in audits and staff training.
4. Oversee medical record compliance and risk management audits; advise staff on coding and documentation.
5. Perform quarterly audits; review results with providers and recommend improvements.
6. Identify recurring compliance or documentation issues and develop corrective actions.
7. Maintain relationships with internal and external stakeholders, including regulatory agencies.
8. Stay updated on quality measures, pay-for-performance programs, and regulatory standards.
9. Collaborate with leadership to develop practice guidelines and compliance tools.
10. Audit clinical charts for adherence to guidelines and standards.
11. Serve as a resource and trainer for quality and compliance issues.
12. Maintain documentation for leadership and regulatory reporting.
13. Coordinate compliance efforts across departments.
14. Develop and update policies to ensure safety and compliance.
15. Manage Risk Management programs and analyze data to improve patient safety.
16. Conduct educational programs on risk and quality improvement.
17. Report on clinical operations and participate in strategic planning.
18. Other duties as assigned by the CEO.

Qualifications:

• Graduate of an accredited nursing program; BSN preferred. Recent clinical experience required.
• Experience in Case Management, Quality Assurance, Compliance, or Wellness preferred.
• Minimum five years of utilization management or audit experience; knowledge of CPT, HCPCS, ICD-9, Medicare, and Medicaid billing.
• Strong understanding of quality improvement programs and regulatory standards.
• Excellent interpersonal, organizational, analytical, and communication skills.
• Proficiency with computer software and equipment.
• Ability to work independently, exercise judgment, and maintain confidentiality.

Additional Information:

• Position requires a background check, health screening, and drug test.
• Location: Middletown, Franklin, OH 45042, 45005.
• Schedule: Day shift, Monday to Friday, in person.
• Benefits include health insurance, assistance programs, PTO, retirement, and more.