Quality Compliance Program Manager- HSC Home Care

Jun 10, 2021
Jul 15, 2021
Full Time
The Quality Compliance Program Manager leads clinical quality outcome activities at HSC Home Care, LLC and HSC Health & Residential Services by supporting clinical business decisions, operational processes and internal process improvement initiatives to improve reliability of care and outcomes of the best healthcare services while managing costs. He/she evaluates, develops, analyzes and implements strategies to enhance clinical, administrative and process outcomes, in collaboration with HSCHC Leadership to ensure delivery of exceptional quality health care and services. Works collaboratively with the HSCHC Management Clinical teams to ensure that desired outcomes are achieved while minimizing and /or mitigating clinical and financial risk. He/She participates in monitoring the quality and compliance of clinical documentation and participates in organization-wide projects that achieve and maintain an effective quality and compliance program. This role demonstrates initiative and creativity in addressing compliance, quality and client safety issues related to State and Federal regulations and CHAP standards.

The HSC Health Care System is a nonprofit organization combining the resources of a care coordination plan; (Health Services for Children with Special Needs, Inc.), pediatric specialty hospital (The HSC Pediatric Center), home health agency (HSC Home Care, LLC), and parent foundation (The HSC Foundation) to offer a comprehensive approach to caring, serving and empowering people with disabilities. The HSC team of 750 employees and more than 100 volunteers together serve children and young adults with special health care needs and their families at our District of Columbia and Maryland locations.

Mission Statement

HSC Health Care System provides and coordinates innovative, high quality, community-based care for individuals with complex needs and their families. HSC empowers all we serve to improve the quality of their lives.

Organizational Beliefs
HSC supports individuals and families to maximize their potential. The following beliefs drive our work. HSC believes that:
- A culturally diverse community is a strength.
- Inclusiveness for individuals, families, and staff promotes positive outcomes.
- Everyone should be treated with compassion and empathy.
- Our skillful, dedicated, and resourceful staff is key to our success.
- We must continually adapt to the changing needs of our community.
- Increased independence is an important goal for individuals and their families.

Essential job duties:

1. Assists operational and clinical leaders, including leadership to monitor home health compliance standards through standard data review ensuring quality compliance improvement information is reported in a timely manner.
2. Assists with current and retrospective chart reviews ensuring compliance with state and national standards.
3. Develop action plans to improve identified areas of opportunity for quality improvement activities including non-compliance, standardization and reduction of variation in clinical practice.
4. Supervises Clinical Resource Nurse role to develop clinical training pathways and optimal staff & client outcomes.
5. Participates in the assessment, monitoring and evaluation of CHAP standards, Federal and State regulations including Home Health COP's to ensure compliance.
6. Monitors national Patient Safety goals and organizational quality plan to identify trends and gaps in regulatory compliance.
7. Monitors safety and event reporting, ensures all events are entered and appropriate follow up is completed.
8. Collaborates with leadership to identify Home Health educational materials for staff to ensure home health compliance, accuracy and documentation effectiveness.
9. Maintains professional growth through ongoing education related to current Home Health practice and quality improvement trends.
10. Maintains expertise through continuing education programs and formal/ informal practice.
11. Advises leadership, as well as colleagues utilizing knowledge and acts as a consultant including group education when needed.
12. Maintains a strong working knowledge of the principles and practices of project and change management, including standard work, planning and organization as well as metrics for project success and sustainability.
13. Maintain ongoing competency with quality improvement models - such as IHI Model for Improvement, TeamStepps, and Lean Management Systems.
14. Demonstrate teamwork by providing coverage in the department as needed.
15. Participates in survey readiness and serves as a liaison to facilitate onsite surveys and accreditation process.
16. Conducts programmatic investigations of serious incidents/allegations and provide to the COO as directed.
17. Maintains ongoing capabilities/expertise and utilizes the client clinical management system used by the organization for reports production and analysis.
18. Creates and maintains programmatic reports and dashboards to track and report progress timely on quality improvement outcomes, identify gaps in current performance and strategies to achieve improvement with sustainability.
19. Attends and participates in organization and external meetings as directed.
20. Serves as Client safety committee chair inclusive of Emergency Preparedness and leads for both organizations.
21. Oversees credentialing and maintenance of organizational personnel training and competency records to ensure all agency personnel comply with required trainings.
22. Partners with organizational leaders to follow-up on internal and external audit reports and assist in the development of corrective action plans and organizational responses.
23. Participates in the formulation of departmental long term and short-term objectives.
24. Participates in Strategic Planning for the organization.
25. Participates in establishing and enforcing compliance standards for the organization's accreditation CHAP standards, federal, state and local regulatory requirements.
26. Reviews incident reporting and participates in 2nd level incident investigations.
27. Support administrative department in prebilling claims review and prepares administrative report to identify denial trends for compliance audit purposes.
28. Responsible for reviewing and updating standard operating procedural manuals and maintaining the organizations electronic policy and procedure drive.
29. Perform chart reviews; recommend interventions and education to improve client care services, coordinates with staff to resolve documentation-related billing issues, and performing evaluations of the organization.
30. Perform monthly chart audits, home SPOTT visits and office inspections, for HIPAA to support compliance with accrediting bodies, federal and local regulations.
31. Develops/updates analytical tools using an in depth understanding of healthcare data (e.g. patient, claims, financial, clinical and provider data) and operations coupled with the knowledge of large data set development and quantitative data analysis methodology, interpreting and disseminating results to key audiences. Integrates quality data throughout HSC Home Care to ensure, enhance, and support client safety.
32. Home visits as needed to provide supervision and evaluation of staff and/or patient care during times of excessive volume.
Other job duties:
1. May perform other duties in addition to those outlined in this job description.


Employee Excellence, All In, Action-oriented

Employee Excellence
• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence standard is achieved
• Innovates through improvement of care and/or efficiency of operational processes.
• Dedicated to a standard of performance excellence and high quality.
All In
• Embraces changes/improvements and actively participates in the implementation of new/improved programs, technology, new equipment, systems and resources that promote quality of care, safety and efficiency
• Identifies, prioritizes and selects alternative solutions to determine best outcome
Action Oriented
• Maintains a high level of activity/productivity, meeting deadlines and appropriately prioritizing tasks to meet business demands
• Anticipates problems and attempts to solve before they develop

Leadership Excellence, Collaboration, Leadership Skills

Leadership Excellence
• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence is achieved
• Innovates through improvement of care and/or efficiency of operational processes.
• Dedicated to a standard of performance excellence and high quality
• Creates a safe environment that encourages brainstorming, creativity and "out-of-the-box" thinking
• Encourages a diverse group of people to communicate effectively and embrace creative thinking
• Drives the collaborative efforts of the team to achieve goals in the most effective and efficient way
• Demonstrates listening and feedback skills
Leadership skills
• Proactively assumes responsibility and accountability for results to include management of organizational change
• Empowers staff in ensuring a culture of transparency, fairness, respect and excellence
• Strategically aligns operational and tactical objectives to drive business results.
• Encourages collaboration with team members based on trust, mutual respect, consistent visible support, and open and honest communication.


Required Experience:

-At least three (3) to five (5) years of experience in developing, implementing, and evaluating clinical program standards & initiatives inclusive of clinical program evaluation.
-Five (5) to Seven (7) years of professional clinical experience to include but not limited to Home Care, Critical Care, Emergency Care etc.
-Registered Nurse required with minimum of 5 years progressive managerial experience.
-Must have working knowledge of Community based practices (home health).
-Ability to work under pressure, with strong organizational and analytical skills.
-Demonstrated project management skills with the ability to handle multiple concurrent projects.
-Ability to work effectively with providers and multidisciplinary teams across departmental lines.
-Familiar with CMS/DOH/DHMH/CHAP regulations.
-Excellent written and verbal communication skills.
-Intermediate to advanced knowledge of MS Office Suite (Word, Excel, Access, PowerPoint and Outlook).
-Data collection and analysis skills required; skills working with relational databases preferred.


-RN License in State of Maryland and District of Columbia.
-Obtain CRMP within 12 months of employment.

Required Education:

-Bachelor's Degree in Nursing required, Master's Degree (MS, MSN, MPA or MPH) strongly preferred.


-The incumbent will be responsible for the general direction of several staff members and manages staff performance.

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

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