Somnia Anesthesia works with hospital and OR leaders to provide efficient anesthesia staffing solutions and utilize sound, evidence-based clinical decision-making. Somnia’s extensive national administrative infrastructure provides support in almost every facet of anesthesia and perioperative management, including billing, payer contracting, recruiting, credentialing and other key services that are necessary for a high-performing operating room anesthesia department. Crain’s New York Business named Somnia one of the 50 fastest growing companies due, in part, to our unwavering commitment to partnering with best-in-class clinicians committed to clinical quality excellence, operational effectiveness, and patient and surgeon satisfaction.
Somnia is seeking a proficient, outcome-oriented Director of Quality and Compliance to provide direct support for a variety of initiatives within the Quality Management and Compliance areas. Reporting to the Chief Operating Officer the Director of Quality and Compliance will contribute to efficiently and effectively provide consistent support and ensure all department objectives exceed expectations in a timely fashion.
The Director of Quality and Compliance is responsible for managing day to day operations of the Quality Management Program (QMP), analyzing risk management data, compliance and incident reports to promote best practice and improve patient and staff safety, conducting and facilitating educational programs based upon identified needs, initiating performance improvement projects, MACRA compliance and facilitate compliance with Accreditation standards. Works collaboratively with Compliance Officer, Chief Legal Officer and Chief Operating Officer to develop auditing programs, regulatory update communications and process improvement. Act as a trusted adviser and key point of contact for facility operations regarding the Quality Management Program including the Merit-Based Incentive Payment System (MIPS), regulatory and state guideline updates, AAAHC changes, The Joint Commission updates, CMS requirements and the ASA/AANA initiatives and how it might affect the practice.
- Works in collaboration with Administrators and VP of Operations to monitor, develop, implement new compliance and performance improvement initiatives.
- Build and maintain expertise about the Medicare Quality Payment Program including future impacts to the organization.
- Monitor monthly the QMP metrics for all eligible providers, performing ongoing audits to ensure compliance and mitigate risk to Somnia.
- Prepare reports/deliverables for submission to meet QMP requirements including monthly action plans to participating providers as part of continuous process improvement.
- Develop and implement QMP educational tools for onboarding and ongoing training of providers and staff.
- Present information in large and small group settings related to the QMP and/or other identified Quality metrics.
- Advise and assist in implementation of PSH or ERAS initiatives company-wide relating to quality and quality program planning.
- Works closely with Compliance Officer to develop process improvement plans and innovative project development.
- In coordination with the Compliance Officer, conducts or coordinates investigations into compliance related issues or reports and organize and participate in Compliance Committee meetings.
Quality and Patient Safety
- Identify gaps for quality improvement, quality reporting and use QI methodology to improve outcomes.
- Identify opportunities for PSH and ERAS implementation
- Annually publishes at least three publications in peer review journals pertaining to Quality Management Program.
- Develops compliant reference policy manuals for Departments based on operational and clinical compliance needs.
- Identifies statistical trends, and potential issues in patient care and services. Works collaboratively with physician offices on Quality Improvement studies including developing corrective plans and monitoring their effectiveness.
- Works closely with the Privacy Officer and the Security Officer to ensure that all HIPAA regulations are monitored and adhered.
- Oversees periodic compliance and quality risk assessments to identify the highest priority risk exposures.
- All other duties as assigned
CORE ORGANIZATIONAL COMPETENCIES:
Teamwork: Demonstrates respect and achieves cooperative relationships in fulfilling the mission and vision of Somnia Anesthesia.
Communication: Demonstrates good interpersonal skills with all whom they interact. All communications, verbal and written, should demonstrate a commitment to internal and external customer service and excellence. Effectively sends, receives, and responds to requests while maintaining a high level of confidentiality.
Initiative: Committed to and performs quality work contributing to the strategic goals of the organization. Assumes responsibility and accountability for his/her actions. Meets the challenges of a changing environment, is timely in meeting job responsibilities. Values accomplishments and shows enthusiasm and pride in the organization. Demonstrates a self-directed work effort. Develops goals for professional growth and strives to achieve those goals.
Customer Service: Demonstrates a commitment to courteous, sincere, and sensitive customer service. He/she presents a positive and caring attitude in all interactions. He/she is patient, tolerant, accepts diversity, and presents a positive image of themselves in all professional interactions.
Quality Improvement: Demonstrates a commitment to quality and excellence. He/she solves problems through critical evaluation of data-based information and application of continuous quality improvement methods. Can accurately identify and diagnose issues, perform preventative actions and analysis, identify alternatives, implement a plan, and evaluate and communicate results.
- Bachelors or Master’s degree in a healthcare related field, in lieu of degree, 5+ years of relevant experience considered
- Registered Nurse or Physician Assistant (or other comparable clinical credentials) with one to three years of previous Quality/Risk/Patient Safety work experience preferred
- Minimum of 3 years of experience in the health care environment required
- Certified Professional in Healthcare Quality (CPHQ) preferred
- Certified Healthcare Compliance Certification or equivalency is desired.
- Experience auditing organizational records and documentation is preferred.
- Must have, or develop an expert knowledge of national and state laws and regulations including but not limited to:
- False Claims Act
- Physician Self-Referral (Stark) Anti-kickback statute
- Health Insurance Portability Act (HIPPA)
- Health Information Technology for Economic and Clinical Health (HITECH)
- State regulations application to anesthesia reimbursement under Medi-Call and Medicare Care
- Basic utilization review/survey procedures and techniques
- Strong experience with reporting for the EHR Incentive Programs, Perioperative Surgical Home, ERAS Development and/or PQRS
- Experience with ICD-9/10, CMS (MIPS, MU, PQRS), and Accreditation (ex: AAAHC, Joint Commission, AAASF etc.)
- Thorough knowledge and understanding of quality improvement tools and experience with process improvement
- Demonstrated ability to achieve positive outcomes on quality improvement projects
- Experience in teaching health care providers, clinical and non-clinical staff
- Strong analytical skills with intermediate to advanced knowledge of Excel
- Proficiency in the use of computer applications, including Microsoft Word, Excel, PowerPoint, and EHR systems
- CPHQ, PMP or Six Sigma certification is beneficial
- Ability to work well independently and within a team structure, both virtually and in-person
- Excellent communication and presentation skills, including public speaking
- Excellent project management and organization skills
Availability for out of state travel demand to facilities for project implementation or management.
Job Type: Full-time