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Director Licensing Accreditation/Regulation Compensation

Company: Kaiser Permanente
Location: Riverside
Posted on: May 16, 2022

Job Description:

Through subordinate managers and/or staff, directs the planning, delivery and evaluation/improvement of programs/services related to licensing, accreditation, regulatory compliance and contract compliance within a Service Area including preparation for, compliance with, and follow up for all surveys such as CALS, NCQA, CAP, DHS, OSHA, MDQR, HCFA, DMC, etc. Contract compliance may include but not be limited to MediCal and Medicare contracts. Collaborates with administrators, managers, chiefs of service and other physician leaders to assist with and coordinate all regulatory /compliance functions. Ensures that all areas of risk/vulnerability with regard to accreditation, licensing and contract compliance are identified and that monitoring and corrective processes/systems are in place. Works with departments and/or teams to develop quality action plans for improvement. May also include responsibility for directing Credentialing, Member Services, Customer Service or other services/programs on a Service Area-wide basis.
Essential Responsibilities:


  • Directs the development, planning, delivery and evaluation/improvement of all assigned departments/functions and integrates these with larger organizational, business, operational and strategic goals/objectives. Delivers services/programs, which meet or exceed established quality, cost and other performance targets. Measures, assesses and improves internal and external customers' satisfaction with assigned services/programs.

    • Serves as the primary contact for all regulatory and contract agencies: Provides consultative services to all KFH/P and SCPMG departments and services regarding intent of regulations and means to achieve, maintain and improve compliance, contract interpretation and other services/programs.

      • Keeps self and other appropriate personnel informed of changes in legislation and requirements related to regulatory, accreditation, licensing and contract compliance issues. Directs the analysis and reporting of regulatory agency regulations/requirements and makes Service Area-wide recommendations for all compliance policies, procedures and contract interpretation.

        • Assures continuity and consistency in compliance with regulatory and compliance issues across the Service Area on by evaluating the impact of specific issues. Collaborates with appropriate departments to develop and implement corrective action plans to minimize negative impact, maximize performance outcomes and address regulatory deficiencies.

          • Identifies key accreditation, regulatory, licensing and contract compliance issues and defines areas, methods and systems/processes for improvement.

            • Communicates information related to accreditation, regulatory requirements, licensing and contract compliance externally and internally. Directs the preparation for all self-studies as well as surveys and inspections conducted by regulatory and accreditation agencies.

              • Maintains positive relationships with representatives of external regulatory, accreditation and contract agencies.

                • Collaborates and coordinates with departments on any implementation and evaluation of legislation affecting the Service Area.

                  • Provides overall staff support to the Accreditation and Licensing Committee and the Medical Executive Committee such as coordinating activities and agenda, managing meeting minutes and action plans and providing research, analyses and recommendations.

                    • Develops and monitors annual budgets for all assigned departments / functions.

                      • Prepares and submits the Annual Competency Report to the Board of Directors and coordinates corrective action plans.

                        • Coordinates and communicates revisions to the Service Area Administrative Policies and Procedures.

                          • Coordinates and communicates revisions to the Service Area Professional Staff Bylaws, Rules and Regulations.

                            • Acts as Service Area Compliance Hotline Liaison.

                              • Serves as Corporate Compliance Coordinator to CCRU.

                                • Coordinates surveys and audits for internal and external reviews.
                                  Basic Qualifications:
                                  Experience

                                  • Minimum six (6) years of experience in the management of clinical operations.
                                    Education

                                    • Bachelor's degree in health care or business administration, public health, nursing or other related field, OR four (4) years of experience in a directly related field.

                                      • High School Diploma or General Education Development (GED) required.
                                        License, Certification, Registration

                                        • N/A
                                          Additional Requirements:

                                          • Ability to demonstrate and utilize knowledge of quality improvement/management processes, techniques and systems.

                                            • Working knowledge of federal and state laws and regulations such as JCAHO, NCQA, Knox-Keene Act, Federal HMO Act, Health Care Financing Organization (HCFA), CMRI, Public Employees Medical and Hospital Act, applicable MediCal and Medicare regulations and rulings, and California Medical Review.

                                              • Demonstrated ability to utilize skills and knowledge related to adult learning and motivational theories, statistical analysis, quality management and performance improvement processes.

                                                • Demonstrated ability to utilize oral and written communication skills.

                                                  • Must be able to work in a Labor/Management Partnership environment.
                                                    Preferred Qualifications:

                                                    • Master's degree in health services or business administration or other relevant field preferred.
                                                      PrimaryLocation : California,Riverside,Riverside Medical Center/Medical Offices 1
                                                      HoursPerWeek : 40
                                                      Shift : Day
                                                      Workdays : Mon, Tue, Wed, Thu, Fri
                                                      WorkingHoursStart : 08:00 AM
                                                      WorkingHoursEnd : 05:00 PM
                                                      Job Schedule : Full-time
                                                      Job Type : Standard
                                                      Employee Status : Regular
                                                      Employee Group/Union Affiliation : NUE-SCAL-01-NUE-Non Union Employee
                                                      Job Level : Manager with Direct Reports
                                                      Job Category : Compliance, Privacy & Regulatory
                                                      Department : Riverside Med Center - Hosp Adm-Survey Accredita Prep - 0801
                                                      Travel : No
                                                      Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

Keywords: Kaiser Permanente, Riverside , Director Licensing Accreditation/Regulation Compensation, Human Resources , Riverside, California

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