Director of Quality, Risk Management, and Compliance

Upstate Family Health Care Inc. is a Federally Qualified Health Center (FQHC) and we are expanding in the Mohawk Valley. Hours of operation are Monday – Friday 8:00 am – 6:00 pm.

The Director of Quality, Risk Management, and Compliance is responsible for overseeing and directing all activities related to quality improvement, risk management, and regulatory compliance within the Federally Qualified Health Center (FQHC). This role ensures that the organization maintains high standards of care and operates in compliance with federal, state, and local regulations. The Director will develop and implement strategies to enhance patient care quality, minimize risks, and ensure adherence to applicable laws and guidelines.

The Director Quality, Risk Management and Compliance reports to the Chief Medical Officer.

Qualifications

• Master’s degree or higher in a field related to leadership or a specific clinical specialty.
• Certification in provider discipline.
• No less than 3 years of experience in a leadership position in healthcare, preferably an FQHC.
• Interpersonal skills that allow effective interaction with clients and multiple providers while maintaining a spirit of hope and empathy.
• Proficiency in Microsoft Office Suite, Electronic Health Records (EHR), and familiarity with regulations governing healthcare and practice scope.
• Experience in dealing with a diverse and dynamic workforce.
• Experience partnering with Executive Leadership and Board of Directors resulting in the development and implementation of operational strategies.
• Experience working in Quality Assurance, Risk Management, and Compliance.
• Previous supervisory/managerial experience preferred.
• Experience working with a non‑profit community health center preferred.
• Experience working with clinical informatics databases containing Protected Health Information.

Responsibilities

Quality Improvement

• Develop, implement, and manage the organization’s Quality Improvement (QI) program to enhance patient care and operational efficiency.
• Monitor and evaluate clinical performance indicators and patient outcomes.
• Facilitate and lead QI initiatives, including setting goals, developing action plans, and tracking progress.
• Conduct regular audits and assessments to ensure compliance with internal policies and external regulations.
• Have a working knowledge of a comprehensive health quality program (e.g., patient safety, peer review, and infection control).
• Ensure accomplishment of the organization’s mission through creating infrastructure that enhances clinical and quality outcomes.
• Ensure continuous improvement by evaluating and making recommendations considering market demands, regulatory standards, and clinical practice.
• Work closely with the CMO and key stakeholders to ensure all clinical and quality metrics are accomplished.
• Ensure that Quality Improvement compliance standards are met for all major grants and funders (FQHC/HRSA, FTCA, DHH/HRSA (Ryan White), HHS, etc.).
• Work closely with the Grants Manager and assist in grant writing for new funding sources and competitive and non‑competitive grant renewals for continued funding.
• In coordination with the CMO, develop, implement, and enforce clinical policies in accordance with funding requirements.
• Chair the Quality Management program of UFHC and attend at least one Quality Improvement conference per year.
• Work with Clinical Leadership and Practice Management to create custom reports needed for ongoing maintenance of quality care and operations.
• Respond to ad‑hoc internal data requests from Leadership.
• Oversee clinical applications to ensure quality and data accuracy and cohesive workflows (i.e., EHR, etc.).
• Monitor clinical compliance of medical providers (MD, NP, PA, and RN) and share findings with the CMO, Senior Director of Clinical Operations, and through regularly generated reporting (e.g., note closure, proper billing, performance‑measure feedback).
• Responsible for quality incentive programs, CCA, ACO, and IPA.

Risk Management

• Identify potential risks and implement strategies to mitigate them, including the development of risk‑management policies and procedures.
• Conduct risk assessments and develop action plans to address identified risks.
• Oversee incident reporting and investigation processes to identify trends and prevent recurrence.
• Provide training and support to staff on risk‑management practices and protocols.

Compliance Management

• Serve as program administrator for FQHC/HRSA, FTCA, DHH/HRSA (Ryan White), HHS funding grants.
• Ensure the organization complies with all federal, state, and local regulations, including those specific to FQHCs.
• Develop and update compliance policies and procedures to reflect changes in regulations and best practices.
• Conduct regular compliance audits and reviews to identify and address potential issues.
• Serve as the primary point of contact for regulatory agencies and manage compliance‑related correspondence and documentation.

Leadership and Team Management

• Lead and mentor the Quality, Risk Management, and Compliance team to foster a culture of continuous improvement and accountability.
• Collaborate with other departments to integrate quality, risk management, and compliance efforts into overall organizational operations.
• Develop and deliver training programs to educate staff on quality improvement, risk management, and compliance matters.
• Supervisory responsibilities are subject to change based on organizational needs and department growth.

Reporting and Communication

• Prepare and present reports on quality, risk management, and compliance activities to senior management and the Board of Directors.
• Communicate effectively with staff, patients, and stakeholders regarding quality, risk, and compliance issues.
• Stay current with industry trends, best practices, and regulatory changes to ensure the organization remains up‑to‑date and compliant.
• Administer and analyze the annual Patient Satisfaction Survey.
• Coordinate quarterly Continuing Quality Management Committee and monthly sub‑committees.
• Coordinate and manage Quality Improvement Projects.
• Present monthly reports to the QPI Committee of the Board and quarterly updates to the Board of Directors, including key data reports, progress reporting on QI projects, annual updates on UDS and patient satisfaction, and other key quality assurance activities.
• Develop, update, and maintain Quality Improvement/Assurance and Clinical Application policies and procedures and present them to the Board of Directors for review and approval as needed.
• In coordination with the CMO, design and administer biannual peer‑to‑peer chart reviews.
• Coordinate with Risk Management to design and implement QI projects in response to risk events.
• Ensure timely submission of monthly and quarterly data progress reports required by funders.

Other Duties

• Work environment: Generally works in a clinical office environment but may occasionally be required to perform duties outside the typical clinical setting. Availability for occasional work outside regular office hours.
• Travel requirements: Occasional local travel between the main clinic and SBHCs.
• Work hours: 40 hours per week (Monday‑Friday 8:00 am‑4:30 pm).
• Required screenings: Must complete UFHC credentialing and privileging to provide direct services with Federally Qualified Health Centers.
• Upstate Family Health Center is an Equal‑Opportunity Employer.

#J-18808-Ljbffr