The Compliance and Quality Assurance Manager serves as chief of the Compliance and Quality Assurance Division planning, directing, supervising and coordinating the activities and operations of that division within the Department of Health and Social Services. Compliance and Quality Assurance Manager serves as the Chief Privacy Officer for the Department of Health and Social Services and ensures that the Department’s business and provider practices are compliant with Federal, state and local regulations and requirements; identifies and assesses areas of compliance risk and prepares recommendations that reduce those risks; coordinates assigned activities with other divisions, departments, and outside agencies; and serves as a member and integral part of the Department’s senior management team.
This class is a single-position management level class and is distinguished from the: Director of Health and Social Services class which manages and oversees the functions and operations of the several divisions of the department which include Child Welfare Services, Employment and Eligibility Programs, Older and Disabled Adult Services, Public Health, Quality Management and Compliance, and Mental Health; and theDeputy Compliance and Quality Assurance Manager class which reviews, monitors, and evaluates program areas within the department with a goal of regulatory compliance and quality improvement in customer care and service delivery. This class also serves as a lead over the Compliance and Quality Assurance Analysts and plans, implements, maintains and evaluates training and communication programs to ensure all employees are educated about the compliance program, Code of Conduct, policies and procedures, and other specific compliance issues.
Supervision Received and Exercised
The Compliance and Quality Assurance Manager receives administrative direction from the Director of Health and Social Services.The Compliance and Quality Assurance Manager supervises employees, primarily in the classes of Deputy Compliance and Quality Assurance Manager and Compliance and Quality Assurance Analyst, who are performing compliance and quality assurance reviews.
This class specification represents the core area of responsibilities; specific position assignments will vary depending on the needs of the department.
·Exercises management authority for assigned functions and operations of the Compliance and Quality Assurance Division and fosters a culture of compliance throughout the department by:
·serving as chair of the department’s Compliance Committee;
·serving as the Chief Privacy Officer ensuring the protection of health information and the right of patients to obtain or amend their health information;
·instituting, maintaining, and revising, as needed, a Code of Conduct and other appropriate policies and procedures to ensure compliance with the requirements of federal healthcare programs;
·monitoring and reviewing departmental policies and procedures to ensure regulatory changes in all Federal and state laws, regulations and programs are integrated and implemented;
·monitoring and reviewing contracts and grants to ensure regulatory and fiscal compliance with Federal and state laws and coordinating compliance issues with fiscal oversight staff;
·creating and maintaining an effective line of communication between the Compliance and Quality Assurance Division and all department employees including a hotline to receive complaints or questions and procedures to ensure the anonymity of complainants;
·monitoring providers to ensure compliance with applicable state and Federal regulations;
·monitoring and evaluating the efficiency and effectiveness of customer care and service delivery methods and procedures;
·conducting and coordinating compliance investigations of alleged violations of law, the Code of Conduct, department policies/procedures, etc. for corrective action and to prevent recurrence(s) of a violation;
·identifying potential areas of compliance vulnerability in department business practices and areas at high risk of non-compliance and ensuring corrective action plans are developed to reduce these risks; and
·overseeing the planning, implementing, maintaining and evaluating training and communication programs to ensure that all employees are educated about the compliance program, Code of Conduct, policies and procedures, and other specific compliance issues.
·Performs additional managerial responsibilities such as:
·providing input and recommendations for the division budget in order to fund existing and new programs and services;
·approving division expenditures for workplace improvements, training, computer software and hardware, etc.;
·establishing and monitoring goals and objectives of the unit and taking corrective actions as appropriate;
·recommending and implementing new policies and procedures to eliminate or reduce barriers to efficient or effective production and/or to improve customer service; and
·coordinating and monitoring the work of consultants and contractors by reviewing the performance and quality of work to ensure compliance with the applicable contract and by reviewing and approving claims for payments to ensure conformance with contract provisions and to prevent cost overruns.
·Performs supervisory duties to direct reports such as:
·establishing standards for acceptable work products and evaluating performance;
·interviewing applicants and making selections;
·reviewing, approving and implementing disciplinary actions and terminations;
·providing career development mentoring;
·assigning work and planning and scheduling staff’s work activities and deadlines;
·reviewing work and recognizing employees’ work efforts and accomplishments;
·providing career development mentoring and recommending training and career development opportunities;
·ensuring that employees are properly trained;
·reviewing and approving timesheets and requests for leave; and
·supporting and ensuring compliance with County and Department policies and procedures including those related to equal opportunity and to safety.
Represents the Department in publicizing the quality management and compliance program to the community and establishing appropriate community outreach efforts by:
·developing and maintaining collaborative partnerships with community leaders, local, regional, and statewide organizations, non-profit agencies, local businesses, and other County departments to develop, implement, and/or promote programs and projects consistent with the division’sgoals and services;
·representing the needs and priorities of the department and the division within these “partnerships”;
·representing the Departmentin a variety of community outreach activities and public awareness programs;
·speaking to groups and individuals regarding departmentalactivities and services; and
·participating as an active and contributing member of designated community organizations, committees/project teams, and special interest work groups as a representative of the Department.
·Performs other duties of a similar nature or level as assigned.
Knowledge, Skills & Abilities
·Principles and practices of supervision, leadership, motivation, team building, organization, training, and conflict resolution.
·Operational characteristics, services, and activities of a quality management program.
·Federal and state laws and regulations applicable to unit managed such as: Health Insurance Portability and Accountability Act (HIPAA), Mental Health, Medicare and Medi-Cal requirements, CalWorks/FoodStamps/CalWIN programs including quality assurance standards; In Home Support Services; and False Claims and Anti-Kickback statutes.
·Health care and social service programs provided by counties in the state of California.
·Malcolm Baldrige National Quality Program Health Care Criteria for performance Excellence, the accreditation program of the Joint Commission on the Accreditation of Healthcare Organization, the accreditation program of the Commission on the Accreditation of Rehabilitation Facilities, or other similar programs relating to the inculcation of quality standards into organizations providing health or related services. Principles and practices of budgeting, cost analysis, and fiscal management.
·Funding sources for department programs and services.
·Practices and procedures related to conducting program research and statistical reviews.
·Practices and procedures related to continuous quality improvement.
·Oral communication techniques to include presentations to groups of various sizes in a positive, inclusive, and motivational manner.
·Customer service techniques for dealing with customers, often in a difficult or confrontational situation.
·English composition, spelling, grammar, vocabulary, and punctuation for both written and oral communications.
·Formats and appropriate terminology for written communications such as business correspondence, policies, procedures and narrative reports.
·Standard office procedures, practices, equipment, personal computers, and software.
Skill and/or Ability to:
·Supervise, evaluate, train, and develop staff and organize and manage their work.
·Research laws, regulations, procedures and/or technical reference materials; analyze, evaluate and interpret the data gathered; draw logical conclusions; develop reasonable and deliverable options, make appropriate recommendations; and implement the resultant change effectively.
·Research, analyze and evaluate new service delivery methods and techniques.
·Create systems and processes to ensure compliance issues are resolved in a timely manner.
·Manage a variety of simultaneous work projects and carry them through to successful completion.
·Determine the appropriate course of action and demonstrate personal diplomacy in difficult and/or stressful situations.
·Administer contracts and grants according to designated guidelines and regulations.
·Communicate information and ideas clearly and concisely, both orally and in writing.
·Work with and speak to various cultural and ethnic individuals and groups in a tactful and effective manner.
·Establish and maintain effective working relationships with those contacted in the performance of required duties.
·Represent the office in meetings with representatives from various County and non-County organizations, with local businesses, with customers, and/or with the general public.
·Prepare a variety of written communications to include reports, policies and procedures.
·Maintain accurate records and document actions taken.
·Maintain confidentiality of records and information per pertinent laws/regulations.
·Use modern office equipment to include computers and related software applications.
Education and Experience
·Education: Bachelor’s degree or higher from an accredited college or university with a major in Accounting, Business Administration, Finance, Health Administration, Public Administration, Social Work, or a closely related field;
·Experience: Four years of (1) responsible professional level experience in a public or non-profit social services or public health agency performing regulatory compliance, quality assurance, and/or regulatory investigations and/or (2) supervision of a health care or social services unit.
Note: The possession of supervisory experience is desired and may be considered during the rating and/or selection process.
Applicants are required to possess a valid California Driver’s License, Class C.
Employees are required to obtain a Healthcare Compliance Certificate from the Health Care Compliance Certification Board within one year of appointment.
·Possession of one of the following valid licenses issued by the State of California may be considered during the rating and/or selection process: Physician; Licensed Psychologist; Licensed Clinical Social Worker; Licensed Marriage, Family and Child Counselor; or Registered Nurse.
·All licenses, certificates and registrations must be kept current while employed in this class.
Background Checks: The County may conduct a background check and a reference check on candidates prior to appointment to a position within this class.
Independent Travel: Employees in this class are required to travel independently, for example, to perform work at other work sites, to attend meetings with other County employees, to attend meetings with community organizations, etc.
Hours of Work: Employees in this class may be required to work weekends, holidays, irregular hours, on-call, and after normal business hours.
Office Work: Employees in this class will most often be working in an office setting.
Work in a Medical Clinic Facility: Employees in this class may occasionally be working at a medical clinic facility and thus will be subject to exposure to chemicals, toxic agents, blood and other bodily fluids, and communicable diseases.
Traffic Hazards: Employees in this class will be required to operate a vehicle and thus will be subject to traffic hazards while driving.
Disruptive/Confrontational Human Contacts: Employees in this class may be subject to disruptive and confrontational people.
Working Alone: Employees in this class may be working at night and/or on weekends, and thus may working alone for extended periods of time.
PHYSICAL REQUIREMENTS :
Mobility and Dexterity: Employees in this class will be stooping, kneeling, reaching, standing, walking, fingering, grasping, feeling (i.e. sense of touch), and performing repetitive motions.
Lifting, Carrying, Pushing and Pulling -- Light Work: Employees in this class will be exerting up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
Vision: Employees in this class will need to have close visual acuity, with or without correction, to prepare and analyze data and figures, transcribe, view a computer terminal, read, etc. Employees in this class are also required to have depth perception in order to operate a motor vehicle.
Hearing/Talking: Employees in this class will be required to perceive the nature of sounds at normal speaking levels with or without correction, and have the ability to receive detailed information through oral communication. Positions in this class require the employee to express or exchange ideas by means of the spoken word.