OVERVIEW

The Compliance Coordinator monitors business activities for compliance with applicable rules and regulations and assists in the development and implementation of compliance programs for the organization. The incumbent will assist in directing and managing of quality assurance, program planning, utilization review, medical record management activities, human rights and compliance activities for the agency. The position serves as serves as the ombudsperson for the agency and provides a central point of entry for consumers and family members to address issues and concerns about the programs and services of RACSB. Work is performed under general supervision and is guided by agency policies and procedures, Human Rights guidelines, professional practices and including ethical standards related to client interactions, state and federal licensure and accreditation regulations and guidelines.

DUTIES AND RESPONSIBILITIES

Provides supervision to Compliance Team who perform incident report management and record reviews.
Assists and organizes workflow to ensure team members understand their duties and delegated tasks.
Serves as lead in the absence of the Director of Compliance and provides general supervision to team members.
Maintains close liaison with administrative and service delivery sites, attends program staff meetings at least once per quarter.
Prepares for and coordinates on-site surveys for licensure, accreditation and utilization review compliance.
Responds to community stakeholder questions about RACSB service and concerns.
Keeps informed of state, federal, and private insurance regulations and policies related to behavioral health and developmental services.
Assures that staff comply with agency policies regarding access to care and length of treatment.
Prepares and reviews reports to analyze agency compliance and quality of care of individuals served.
Stays abreast of and disseminates agency, state, and federal regulations and policies pertaining to the service delivery system.
Hires, trains, plans the work of, supervises and evaluates professional staff.
Coordinates with program staff on corrective action plan implementation to promote quality services and cost-effective results and follow-up on those plans.
Serves as an informational resource to individuals served and their family members and helps resolve general conflicts involving RACSB services.
Investigates human rights complaints, completes investigations reports and letters of investigation findings.
Provides consultation on human rights and regulatory issues through working closely with program staff to ensure compliance with human rights regulations.
Consults with regional advocate and other advocates for individuals served, as necessary.
Maintains records and documentation on all calls for assistance and complaints.
Conducts new employee orientation regarding Human Rights, Health and Safety and other agency policies.
Develop, organize and conduct training on various issues related to quality assurance and Human Rights as necessary.
Monitors and makes recommendations on all incident reports, investigations, and other required agency documentation.
Complete "point in time" consumer satisfaction survey and enters survey results as needed.

KNOWLEDGE, SKILLS AND ABILITIES

Specialized knowledge of human rights regulations, mediation techniques and training procedures. Extensive knowledge of advocacy and consumer support systems within the local community as well as on the state and federal levels. Demonstrated ability to communicate effectively both verbally and in writing, to evaluate program needs and utilize available resources effectively and prepare related documentation and reports, and to implement agency policies and procedures in managing program areas. Thorough knowledge quality assurance program activities and requirements, program development and implementation, evaluation tools and techniques; thorough knowledge of licensure, certification, national accreditation, utilization review and evaluation standards and related essential risk management; considerable knowledge of general clinical practices and service delivery requirements of professionals in a community service system; considerable knowledge of directly and contractually operated programs and services of the Board; considerable knowledge of state Medicaid financing and private insurance requirements related to the populations served; ability to establish and maintain effective working relationships with staff of the agency and other private and public agencies and organizations; ability to communicate effectively orally and in writing, make presentations and conduct training; ability to operate a vehicle; ability to collect, compile and evaluate electronically sourced or other sourced statistical and financial data and prepare complex recommendations, proposals, reports, etc. Extensive knowledge of advocacy and individual support systems within the local community. Demonstrated ability to perform work dependably and independent of direct staff supervision. Computer literacy: Word, Excel, and Power Point.

TYPICAL EDUCATION, TRAINING AND WORK EXPERIENCE

Bachelor Degree in Human Services with professional experience in behavioral health utilization management preferred, or a combination of education, training, and experience that provides the required knowledge, skills and abilities.

LICENSURE AND CERTIFICATIONS

Valid Virginia driver's license.

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