Care Delivery Compliance Specialist

Leads, oversees, develops, implements, and maintains compliance programs and plans aimed at facilitating ethical and legal conduct, centralized dissemination of information and guidance on federal and state laws and regulations, accreditation and licensing requirements. Develops, implements, and coordinates the audit process, providing analysis and findings to the Senior Leadership. Identifies areas of risk for compliance. Develops, implements, and monitors work plans for correction.

Provides clinical expertise in specific area as appropriate.

• Works as consultant and project manager on compliance issues on existing and planned operations. Participates in the development and implementation of project support regarding departmental changeovers and reorganizations.
• Development of key metrics that impact multiple goals and initiatives across the Region.
• Participates in the development and implementation of internal audits. Coordinates the audit process, including reviewing, analyzing, and reporting findings to Senior Leadership, and to compliance committees.
• Provides consultation on corrective actions related to clinical and health services delivery operations.
• Performs risk assessments and operation overviews of relevant hospital, clinic, and ancillary departments. Determines possible weaknesses and/or vulnerabilities as related to possible regulatory intervention activities.
• Acts as consultant and project manager in the development of policies relating to compliance. Provides clinical expertise for areas of compliance which involve medical necessity and/or quality concerns.
• Maintains relationship with National Compliance Office Care Delivery Team.
• Makes recommendations for a corrective action plan when a confirmed compliance deficiency is identified.
• Participates in the development and implementation of education programs to ensure all appropriate parties are knowledgeable about their compliance responsibilities.
• Incorporates the MHS Nursing Vision, Model and Values through out their Nursing Practice.

• Minimum five (5) years of project management, consulting, healthcare auditing and investigation, or related experience.

• Bachelors degree in business administration, public health, health administration, nursing or related field OR four (4) years of experience in a directly related field.

• Registered Nurse License (Hawaii) required at hire

• Demonstrated knowledge of related federal and state laws and regulations, hospital/clinical systems, processes, and operations.
• Demonstrated ability to consult, advise, and translate customer needs into solution alternatives.
• Demonstrated knowledge of and skill in change management, conflict resolution, investigation, risk assessment, decision making, group process facilitation, influence, interpersonal relations, oral communication, problem solving, project management, systems thinking, team building, and teamwork.

• Masters degree in business administration, public health, health administration, or related field.