Clinica Sierra Vista currently operates comprehensive primary care community health centers in the rural and urban areas of Kern, Fresno, and Inyo Counties, located in California, encompassing several thousand square miles of farm land, desert, and mountain areas. Community health centers provide comprehensive primary and preventative health care, including medical, dental and behavioral health services, in areas where access to health care has historically been inadequate. Additionally, we operate multiple health education, prevention and case management programs providing a comprehensive array of health and human services. We serve primarily the low-income and uninsured population, including migrant farm workers, the homeless, and other special populations

Essential Functions:

Clinical Safety:

1. Responsible for the overall growth & development of clinical safety standards within CSV.
2. Implements new and updated plans to target infection control, risk and safety practices.
3. Works with other departments closely to best serve and develop clinical safety goals, report safety incidents to the necessary agencies, and encourage staff development through problem solving, education and accountability.
4. Prioritize key initiatives including regulatory accreditation agencies, CMS reporting, admissions reduction, increased safety scores and shaping Clinica Sierra Vista to become a high-reliability organization.
5. Work in partnership with leadership to inform and implement the strategic direction for quality and performance improvement projects as it relates to clinical safety and infection control, and effectively implement initiatives.
6. Accountable for the development, evaluation, and maintenance of dashboards and performance metrics as it relates to clinical safety and infection control, that are utilized at all levels of the organization to drive quality improvement efforts, ensuring that regular reports on progress are current, relevant and available for distribution.
7. Oversees and plays a direct role in organizational process improvement utilizing Lean methods and principles in strategic, functional and operational efforts, including planning for and leading workflow events and spread of best practices across all Clinica Sierra Vista’s business line.
8. Directly participates in the development, implementation, maintenance, and spread of improvement tools and resources to ensure successful training/support of staff improvement efforts.
9. Designs and provides staff development activities to meet regulatory accreditation standards.
10. Provides technical and clinical support to the Quality/Risk and Nursing Department.
11. Assists other management staff in developing Plans of Correction for improvement processes.
12. Ensure compliance with policy, procedures and protocols; and communicates them to staff and patients. 
13. Provides mentorship and coaching to staff.
14. Works closely in collaboration with all specialized areas within the Clinical Safety and Quality team.
15. Develop Policies and Procedures as needed.
16. Participates in the proper handling of all patient complaints and incident reports with tracking and follow up needed.
17. Provides other administrative support as required.
18. Provides support to the Chief of Clinical Operations, Quality and Risk Management as needed.
19. Participate in Patient Centered Medical Home model at CSV.

Risk Management:

1. Accountable for the development, evaluation, and maintenance of risk dashboards and performance improvement metrics that are utilized at all levels of the organization to drive Risk Management initiatives, Corporate Compliance and HIPAA efforts, ensuring that regular reports on progress are current, relevant and available for distribution.
2. Ensure maximum protection from discovery of all claims/potential claims materials. Coordinate claims investigation and legal defense processes.
3. Maintains strategies for risk assessments, in collaboration with Senior Leadership Team.
4. Provides technical and clinical support to the Risk /Quality Department.
5. Ensure compliance with policy, procedures and protocols; and communicates them to staff and patients.
6. Ensures quality, safety, and environment of care practices are followed
7. Investigate patient complaints, incident reports, grievances and medical malpractice claims.
8. Reviews and recommends revisions to the risk management plan and all risk management policies on an annual basis.
9. Prepares all necessary documentation and promotes compliance with internal policies and external regulations regarding areas of risk management responsibility, including but not limited to sentinel events and root-cause analyses.
10. Develops statistical and qualitative reports on risk management trends and patterns and communicates this information effectively to appropriate audiences.
11. Develops and implements preventive risk management programs. Educates and trains staff in appropriate procedures, documentation, reporting, and follow-up in key areas of risk management interest.
12. Conduct risk-management training programs.
13. Provides mentorship and coaching to staff.
14. Works closely in collaboration with all specialized areas within the Clinical Safety and Quality team.
15. Provides other administrative support as required.
16. Reports and provides support to the Chief of Clinical Operations, Quality & Risk Management as needed.
17. Keep up to date with new and revised state and federal regulations and statutes related to Federally Qualified Health Centers, ambulatory care centers, and patient care. Review and evaluate related policies and procedures and recommend revisions as needed. Create new policies for approval, as needed.
18. Participate in Patient Centered Medical Home model at CSV.

1. Other duties as required.

Claims Management:

1. Investigate patient complaints, incident reports, grievances and medical malpractice claims.
2. Research and report on medical and legal topics.
3. Examine financial and other records for instances of fraud or theft.
4. Manage lawsuits and act as a liaison for liability claims.
5. Review medical records for liability issues.
6. Presents summary information to outside legal counsel and to the Chief Executive Officer with an opinion as to potential for litigation. Manages the documentation and computerized files of all claims.
7. Demonstrates knowledge and implementation of creative and innovative risk management processes.
8. Builds and maintains trusting relationships with both internal and external customers to enhance communication regarding risk and safety.
9. Maintains chain of custody on all medical records with outstanding claims, and maintains all evidence, documents, and communications on legal cases in a confidential manner. Sequesters medical records as necessary.
10. Acts as the primary spokesperson for the facility to persons who have a complaint that may be considered a potentially compensable claim. Aids in analyzing patient complaints and directs inquiries to appropriate personnel.
11. Acts as liaison to outside litigation counsel in the management and investigation of filed lawsuits and related litigation processes. Understands the legal components of the risk management industry.
12. Evaluates all incidents for severity, frequency, and probability of financial loss, and reports as necessary to appropriate administration, committees, and personnel. Develops and maintains an incident reporting system by establishing a comprehensive incident reporting plan that establishes policies, educational programs, and reporting methods for the appropriate areas. Directs information on incidents as appropriate to medical staff and nursing peer review processes. Uses industry bench-marking to compare appropriate data.
13. Analyzes individual occurrence reports and trends to identify opportunities to improve the delivery of safe patient care
14. Implement and ensure compliance to all Risk Management and Quality Assurance practices as outlined by CSV
15. Effectively interact with people and develop positive relationships while being tactful, respectful, and direct in communication
16. Actively participate in a variety of committees as assigned (quality, safety, environment of care, corporate compliance, etc.)
17. Ability to handle highly confidential and sensitive patient information
18. Ensures all clinicians are appropriately credentialed and privileged per CSV policy.
19. Keep up to date with new and revised state and federal regulations and statutes related to Federally Qualified Health Centers, ambulatory care centers, and patient care. Review and evaluate related policies and procedures and recommend revisions as needed. Create new policies for approval, as needed
20. Serve as liaison to external regulatory agencies for purposes of patient and physician reporting, event investigation, and response.

Compliance Management:

1. Directly participates in the development, implementation, maintenance, and spread of Risk Management initiatives, Corporate Compliance, and HIPAA informational tools and resources to ensure successful training/support of staff improvement efforts.
2. Designs and provides staff development activities to meet compliance standards.
3. Promotes compliance with all applicable regulations including but not limited to the Health Insurance Portability and Accountability Act (HIPAA).
4. Acts as the facility’s expert resource in risk reduction and keeps abreast of trends in the industry.

JOB DUTIES AND RESPONSIBILITIES

1. Participates in the governance and compliance of the 340B program as part of the Pharmacy and Therapeutics (P&T) Committee.
2. Lead the CSV Compliance Program to properly establish adequate safeguards to comply with HIPAA obligations
3. Working knowledge of management of an effective compliance program, including training, monitoring, conducting and documenting investigations, addressing violations and monitoring corrective actions.
4. Demonstrated current knowledge of business ethics, legal and compliance risks.
5. Protects privacy for beneficiaries, physicians and employees; ensuring all personal health information is kept confidential-complies with HIPPA regulations i.e., (sensitive papers, charts, and reports are not in view of the public).
6. Develop Policies and Procedures as needed.
7. Keep up to date with new and revised state and federal regulations and statutes related to Federally Qualified Health Centers, ambulatory care centers, and patient care. Review and evaluate related policies and procedures and recommend revisions as needed. Create new policies for approval, as needed

Data Management:

1. Assists with the development of assessment activities and tools to track, analyze, and present outcome measures, process improvement activities, program performance. 
2. Assists with quarterly data and summary reports.
3. Maintains and updates data regarding incident reports, grievances and complaints.
4. Provides reports and data summaries relevant to performance improvement activities.

Knowledge, Skills and Abilities:

1. Must be familiar with all state and federal compliance regulations and standards.
2. Strong analytical and systemic thinking skills, with ability to synthesize information from many sources to develop recommendations.
3. Commitment to staying informed on regulatory changes.
4. Knowledge of Lean, Model for Improvement, PDSA and other quality improvement tools and methodologies, with a record of leading successful improvement projects.
5. Strong record of leadership, project management, and collaboration.
6. Demonstrated analytic skills including use of tables and charts to drive performance.
7. Must possess the ability to facilitate working groups and training sessions with strong presentation and training skills along with excellent verbal and written communication skills.
8. Ability to develop successful interpersonal and professional relationships with diverse populations.
9. Proficiency in planning, coordinating and implementing patient and staff safety procedures.
10. Understanding of change management principles.
11. Knowledge of ambulatory electronic health records.
12. Strong organizational skills to prioritize multiple tasks and projects under tight deadlines.
13. Ability to communicate effectively and respectfully with people of varied racial, educational, and socio-economic backgrounds as well as individuals with disabilities and contagious diseases.
14. Represent Clinica Sierra Vista’s core values with integrity: Social Justice, Cultural Sensitivity, Community, and Excellence.
15. Willingness and ability to travel to all CSV sites, as needed.
16. Ability to handle highly confidential and sensitive patient information.
17. Promotes and believes in CSV’s mission statement.