Director Quality, Compliance & Risk

CORE JOB SUMMARY                                                                                                                        

The Director of Quality, Compliance & Risk Management is responsible for leading, implementing, and overseeing HealthyMD’s organization-wide quality improvement, regulatory compliance, and enterprise risk management programs. This role ensures the organization consistently meets federal, state, and accreditation requirements while fostering a culture of quality, safety, accountability, and continuous improvement.

The Director serves as a key advisor to executive leadership and works collaboratively across clinical, operational, and administrative departments to identify risk, mitigate compliance exposure, improve outcomes, and ensure adherence to all applicable healthcare laws and regulations. This role plays a critical part in protecting HealthyMD’s patients, employees, leadership, and organizational integrity.

CORE JOB FUNCTIONS                                                                                                          

1. Quality Management & Performance Improvement

• Develop, implement, and oversee organization-wide quality improvement initiatives aligned with regulatory and strategic goals.
• Monitor and analyze quality metrics, trends, and outcomes; prepare reports for executive leadership and governing bodies.
• Lead continuous performance improvement activities, root cause analyses, and corrective action plans.
• Partner with clinical and operational leaders to improve patient safety, service quality, and operational effectiveness.
• Ensure compliance with accreditation and oversight standards (e.g., HRSA, CMS, Joint Commission, and other applicable agencies).

1. Compliance & Regulatory Oversight

• Serve as the organization’s primary compliance leader, ensuring adherence to federal, state, and local healthcare regulations.
• Oversee and provide leadership for the Compliance Committee and Policy Committee, including agenda development, meeting facilitation, documentation, and follow-up on action items.
• Develop, review, implement, and maintain organizational policies and procedures to ensure regulatory compliance and operational consistency.
• Monitor changes in healthcare laws and regulations and proactively advise leadership on required actions.
• Lead compliance education and training programs for employees, leadership, and providers.
• Oversee regulatory audits, surveys, investigations, and corrective action plans, ensuring timely and effective resolution.

1. Risk Management

• Identify, assess, and mitigate organizational risk across clinical, operational, financial, and reputational domains.
• Oversee incident reporting systems, investigations, trend analysis, and corrective action implementation.
• Coordinate internal risk assessments, compliance monitoring, and audit activities.
• Collaborate with legal counsel, insurance carriers, and executive leadership on claims, grievances, and risk mitigation strategies.
• Ensure accurate completion, maintenance, and submission of OSHA 300, 300A, and 301 logs, including coordination with HR and Operations to investigate workplace injuries and implement corrective actions.
• Develop and maintain enterprise risk management frameworks and reporting processes.

1. Credentialing & Provider Compliance

• Oversee the Credentialing Committee, ensuring compliance with regulatory, payer, and accreditation requirements.
• Ensure provider credentialing, recredentialing, and privileging processes are completed accurately and timely.
• Monitor licensure, certifications, exclusions, and ongoing provider compliance requirements.
• Ensure credentialing documentation is maintained in accordance with regulatory and record retention standards.

1. Leadership, Committees & Governance

• Serve as a trusted advisor to executive leadership and governing bodies on quality, compliance, risk, and safety matters.
• Prepare and present reports to the Compliance Committee, Quality Committee, Credentialing Committee, Policy Committee, executive leadership, and Board as required.
• Promote a culture of transparency, accountability, and continuous improvement across the organization.
• Collaborate with HR, Operations, IT, Grants, and Clinical Leadership to ensure organization-wide alignment.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

CORE QUALIFICATIONS                                                                                                         

Education:

• Bachelor’s degree in Healthcare Administration, Public Health, Nursing, Business Administration, Risk Management, or a related field required.
  Master’s degree preferred.

Certification and Licensing:

• Certified in Healthcare Compliance (CHC), Certified Professional in Healthcare Quality (CPHQ), or Risk Management certification preferred.
• Relevant professional certifications strongly encouraged.

Experience:

• Minimum of 5–7 years of progressive experience in healthcare quality, compliance, and/or risk management.
• Demonstrated experience leading regulatory compliance, audits, and quality improvement initiatives in a healthcare environment.
• Prior leadership or supervisory experience required.

Knowledge, Skills and Attitudes:

In-depth knowledge of healthcare regulatory requirements, accreditation standards, and compliance best practices.

• Strong analytical, problem-solving, and risk assessment skills.
• Excellent written and verbal communication skills, including executive-level reporting.
• Ability to lead cross-functional initiatives and influence stakeholders at all levels.
• High degree of professionalism, discretion, and ethical judgment.
• Ability to manage multiple priorities in a fast-paced healthcare environment.