It’s inspiring to work with a company where people truly BELIEVE in what they’re doing!

When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!

Role:
The Compliance Manager is responsible and accountable for overall implementation, evaluation and monitoring of accreditation and survey readiness for Federal, State, and Local agencies for a mid-size affiliate. The Manager reports directly to Senior Director of Accreditation & Survey Readiness, working with affiliate leadership and clinical staff to meet regulatory requirements, manage risk situations, and maintain standards for Joint Commission accreditation.

Qualifications:

• Bachelor’s degree in related field, or an equivalent combination of work experience and education
• Minimum of three (3) years’ related experience with knowledge of compliance and risk
• Minimum of one (1) year of management/supervisory experience preferred
• Strong business foundation with proven analytical and problem-solving skills
• Demonstrated skills in fiscal management, utilization of analytical and statistical tools, data analysis, and outcomes management
• State and Federal regulation knowledge and current updates
• Knowledgeable in Joint Commission Hospice Standards and the National Patient Safety Goals
• Able to communicate effectively (written and verbal) in English
• Excellent management of group dynamics and conflict resolution
• Knowledge of and ability to apply process improvement theory and process mapping
• Computer knowledgeable and competent with statistical applications and graphics
• Able to work with minimal supervision and exercise a high degree of discretion and independent judgment
• Able to prioritize multiple job responsibilities, exercise critical thinking skills, and effectively handle stress

Competencies:

• Satisfactorily completion of competency requirements for this position.

Responsibilities of all employees:

• Represent the Company professionally at all times through care delivered and/or services provided to all clients.
• Comply with State, federal and local government regulations, maintaining a strong position against fraud and abuse.
• Comply with Company policies, procedures and standard practices.
• Observe the Company's health, safety and security practices.
• Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
• Use resources in a fiscally responsible manner.
• Promote the Company through participation in community and professional organizations.
• Participate proactively in improving performance at the organizational, departmental and individual levels.
• Improve own professional knowledge and skill level.
• Advance electronic media skills.
• Support Company research and educational activities.
• Share expertise with co-workers both formally and informally.
• Participate in Quality Assessment/Performance Improvement activities as appropriate for the position.

Job Responsibilities:

• Participates in all federal, state, and local surveys and accreditation activities for the assigned affiliate, including coverage for another affiliate, as needed, for vacations or time-off.
• Maintains effective communication with all employees promoting: (a) use of the compliance hotline, (b) heighten awareness of the Standards of Conduct, and (c) understanding of new and existing compliance issues related to policies and procedures. 
• Coordinates and facilitates auditing activities relative to comprehensive Compliance Program initiatives and Joint Commission standards. 
• Coordinates Joint Commission activities to maintain deemed status, including annual intra-cycle monitoring reviews for affiliate(s) that occur between triennial surveys.
• Ensures policies and procedures are up-to-date and references to Joint Commission are included for all hospice/home care standards and elements of performance for ease in cross-reference.
• Collects, analyzes, and trends data on patient incidents utilizing the event reporting system.
• Facilitates root cause analyses of adverse events and participates in action plans; monitors implementation and outcome of action plans as related to findings from federal, state, or local accrediting/licensing agencies.
• Identifies needs or seeks direction in identification of needs to maintain expertise and keeps current with health care trends and practices as related to organizational policies and federal, state, or local regulatory statutes.
• Performs other duties as assigned.

This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.