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Understands accreditation/regulatory scoring criteria as it relates to clinical quality improvement, member experience and NCQA accreditation/DOH/CMS regulation and takes the lead in coordinating activities to ensure the standards are met.
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The individual in this position is a key member of the hospital management team, and provides leadership and oversight to the strategic development and implementation of the quality and patient safety programs (performance improvement, patient safety, and accreditation) with responsibility for planning, organizing, directing the managerial and operational activities of the infrastructure required to support these services.
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Federal and state regulatory requirements and accreditation standards: NCQA, The Joint Commission, DHCS, DMHC, CMS and other relevant or accreditation certifying agencies. Monitors and maintains reports published by the Medical Board of California (MBOC), Centers for Medicare and Medicaid Services (CMS), Department of Healthcare Services (DHCS), Office of Inspector General (OIG), NPDB and other applicable sources to identify adverse findings.
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In 2021, the hospital received accreditation from The Healthcare Facilities Accreditation Program (HFAP) , the nation’s original independent accreditation program recognized by the Centers for Medicare and Medicaid Services (CMS.
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Duties, in addition to direct clinical care, will include close collaboration with nursing and social work to maintain Joint Commission and CMS accreditation. We are a primary teaching site for Northeast Ohio Medical University (NEOMED) and Ohio University Heritage College of Osteopathic Medicine (OUHCOM.
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Extensive experience interacting with regulatory and accreditation authorities and a demonstrated history of successfully responding to investigations/inquiries from the Office for Civil Rights, Joint Commission, URAC/NCQA, MA state agencies and CMS among others.
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Knowledge of accreditation standards to ensure adherence to all standards set forth by state and accrediting agencies of TJC and CMS. Rotates weekend RN on-call duties and performs nursing responsibilities as needed.
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Demonstrates appropriate application of age specific standards, policies and procedures and guidelines in caring for pediatric, adolescent, adult, and geriatric patients. This position will provide services that help restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities of patients suffering from injuries or disease.
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Collaborates with the information security officer to ensure alignment between security and privacy compliance programs including policies, practices, and investigations. Lead all privacy investigations of alleged privacy violations and internal investigations of major privacy events and breaches, partnering with legal services and other relevant groups, services, and key stakeholders.
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Thorough knowledge of TJC, CMS and patient safety related regulations and standards. The role will engage staff at all levels, to maintain ongoing compliance with safety initiatives, accreditation standards and regulatory compliance and will participate in activities that support continuous accreditation and regulatory readiness.
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Enters tracer data into accreditation tracking tool; reports from these data are provided to staff to use in staff education and improving compliance with Joint Commission standards and CMS Conditions of Participation (COPs.
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Develop a working knowledge of the DHS/CMS Risk Adjustment process, HEDIS, NCQA Accreditation, and CMS Stars Program. Develop a working knowledge of the DHS/CMS Risk Adjustment process, HEDIS, NCQA Accreditation, and CMS Stars Program.
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Support and implement accreditation, regulatory and compliance activities, i.e. NCQA, URAC, CMS, physician contracts, site visit activities, etc. Research, coordinate and oversee development and implementation of special projects, studies and reports to satisfy information demands of management or various accreditation and regulatory requirements.
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Collaborates with operational and executive leadership ensuring compliance with regulatory bodies to include, but not limited to: Department of Health (DOH), Center for Medicare and Medicaid (CMS) Conditions of Participation, and standards of The Joint Commission (TJC.
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Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQNational Committee for Quality Assurance, and ERISEmployee Retirement Income Security Act of 1974.
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