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Summary:

The Senior Compliance and Quality Specialist - Investigations is responsible for overseeing, coordinating and monitoring PCC’s investigative processes related to OPWDD/NYJC incident management and HIPAA privacy concerns. This role provides direct supervision to assigned staff per organizational structure.

Essential Job Functions

+ Develop and maintain current policies, procedures, and standard operating procedures related to internal and external investigative processes.

+ Oversee investigations and conduct, review and finalize within all applicable regulatory timeframes.

+ Maintain internal incident management reporting systems to promote agency compliance with 14 NYCRR Part 624 and Part 625.

+ Provide support, training, direction and supervision to staff performing incident management functions.

+ Provide technical support related to incident management and privacy concerns to PCC staff.

+ Oversee process to ensure compliance with release of investigative records in accordance with Jonathan’s Law requirements.

+ Develop, implement and train ComplyTrack templates for internal audit, incident and compliance investigations.

+ Create reports in ComplyTrack for data trending.

+ Provide analysis and trending reports to Operations and QI.

+ Conduct/assist with investigating complaints and non-conformance issues.

+ Conduct/assist with supporting on-site audits conducted by external providers.

+ Assist with collecting, compiling, and analyzing statistical quality data to identify areas for continuous quality improvement.

+ Assist in monitoring compliance with all federal/state laws and regulations.

+ Participate on committees and work groups as assigned.

+ Perform any other related duties as required by supervisor.

Knowledge, Skills, and Abilities

+ Knowledge of OPWDD, DOH, and CCO/HH regulations.

+ Experience with services for people with intellectual and developmental disabilities, is preferred.

+ Knowledge of, and experience with continuous quality improvement theories and processes, risk management, and root cause analysis.

+ Must possess excellent time management and communication (written and verbal) skills.

+ Must demonstrate attention to detail, planning and organizational skills.

+ Ability to work collaboratively, independently, and lead/motivate others.

+ Proficient with technology, understanding of electronic health records and data analytics.

+ Maintain professionalism, confidentiality and discretion at all times.

Education and Experience:

+ Bachelor’s Degree (required), Master’s Degree (preferred) in Healthcare Administration, Business, Human Services Administration, Health Information Management or related field.

+ Minimum 2 years of experience within a health care or human services setting.

+ Supervisory experience required.

+ Possession of valid, unrestricted NYS driver’s license required

All experience and education requirements, except when required by federal, state, or local laws or requirements, may be waived at the discretion of management with the approval of the Executive Director, in collaboration with Human Resources.

Physical Requirements/Working Conditions:

+ Ability to sit continuously.

+ Ability to reach above shoulder level.

+ Ability to turn/twist upper body.

+ Ability to use hand for repetitive action and fine manipulating for the purpose of keyboarding.

+ Must be able to travel throughout covered territories in Upstate NY as needed.