Risk and Corporate Compliance Manager

JOB SUMMARY:

Responsible for the coordination, implementation, and oversight of Life Stream's Risk Management and Corporate Compliance Programs. Supports organizational efforts to identify, assess, monitor, and mitigate organizational and regulatory risk while promoting compliance with federal, state, accreditation, contractual, privacy, and payer requirements. Provides leadership and oversight for corporate compliance activities, investigations, grievances, privacy and confidentiality matters, claims management, organizational liability reduction, regulatory reporting, and healthcare risk management initiatives.

Collaborates with operational, clinical, and administrative leadership to foster a culture of integrity, accountability, compliance, ethical conduct, and continuous improvement while protecting the organization's consumers, employees, reputation, assets, and regulatory standing.

Works in partnership with the Director of Safety, Emergency Management & Environment of Care, who maintains responsibility for operational safety functions including safety management, security, workplace violence prevention, emergency management, life safety, environment of care, OSHA compliance, utility management, fire and disaster preparedness, environmental rounding, and safety training programs.

The primary focus of this position is corporate compliance oversight, healthcare risk management, investigations, grievances, privacy and HIPAA compliance, regulatory reporting, claims and liability management, accreditation support, audit activities, and organizational risk reduction.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:
The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification with or without an accommodation. It is not necessarily descriptive of any one position in the class. The omission of an essential function does not preclude management from assigning duties not listed herein if such functions are a logical assignment to the position.

Risk Management Program Administration Coordinate, implement, and oversee the organization's Risk Management Program.

Identify, assess, monitor, and mitigate organizational risks affecting consumers, employees, operations, finances, reputation, and organizational liability.

Maintain oversight of incident reporting systems and risk management processes.

Conduct organizational risk assessments and monitor emerging enterprise risks.

Evaluate organizational practices and services to identify liability exposure.

Corporate Compliance Program Administration Coordinate and oversee the Corporate Compliance Program.

Monitor compliance with applicable laws, regulations, payer requirements, contractual obligations, and organizational policies.

Conduct compliance reviews, investigations, monitoring activities, and audits.

Administer compliance reporting mechanisms and ensure appropriate investigation and resolution of reported concerns.

Evaluate the effectiveness of compliance activities and recommend improvements.

Incident, Investigation, and Grievance Oversight Direct and oversee investigations involving incidents, adverse events, grievances, complaints, privacy concerns, compliance issues, abuse allegations, and potential organizational liability.

Coordinate root cause analyses and corrective action plans related to compliance, risk, grievances, and organizational liability concerns.

Monitor implementation and effectiveness of corrective actions and mitigation strategies.

Chair the Complaints and Grievance Committee and oversee organizational grievance management activities.

Compliance Hotline and Reporting Program Oversight Oversee the Corporate Compliance Hotline and related reporting mechanisms to ensure concerns are received, documented, routed, and addressed appropriately.

Ensure allegations of misconduct, fraud, waste, abuse, privacy concerns, and compliance violations are investigated and resolved appropriately.

Maintain non-retaliation protections for reporting parties.

OIG/SAM Exclusion Monitoring Oversee monthly OIG, SAM, Medicaid exclusion, and other sanction screening activities for employees, contractors, providers, interns, board members, and vendors.

Monitor exclusion status and coordinate corrective actions when necessary.

Fraud, Waste, and Abuse Oversight Coordinate investigations related to suspected fraud, waste, abuse, billing irregularities, documentation concerns, or misuse of organizational resources.

Partner with Finance,…