Office of The Commissioner
The Clinical Compliance Director's role is to provide the staff of Human Services with training in health care, disease state management and/or medication management.
As the Department of Human Services' first Clinical Compliance Director, the focus is to:
- (1) Educate the agency about concept of compliance
- (2) Insure its continuous sense of integrity, and unprejudiced and unbiased judgment
- (3) Empower all clinical programs to comply with laws, regulations, and policies within DHS
The ultimate emphasis of compliance is to assess the direct or indirect delivery of health care to patients and residents, and the empowerment of the health care industry in the Unites States Virgin Islands. This objective is accomplished through providing and requiring the highest level of professionalism, integrity and competence of all health care providers who provide services within DHS.
Ensure that the Clinical staff of the agency comply with the regulatory requirements of a group practice including but not limited to documentation, coding & billing of professional fee reimbursement, HIPAA, Fraud & Abuse Laws, and other local and federal regulations. This mission will be accomplished through educational workshops, clarification of specific regulatory issues, and internal reviews/audits of all departmental clinical areas.
Provide a wide range of quality audit services to Department of Human Services (DHS) consumers (children, seniors, and /or families)
The audits performed by the Director of Clinical will appraise the potential clinical risks associated with various activities and the effectiveness and application of appropriate controls to limit those risks.
The types of audits provided by Internal Audit fall into three main categories:
- Pharmacotherapy Processes Audits
- Compliance/Regulatory Audits
- Other Confidential Audits deemed critical by the Commissioner
The Director of Clinical Compliance will ensure that DHS programs comply with the regulatory requirements of collecting clinical outcomes including but not limited to financial management associated with the Department of Human Services grants, Human Research Protection Regulations, Financial Conflicts of Interest, and other grant reporting requirements. This mission is accomplished through Process Audits, Regulatory Audits, and Financial Audits.
Public Health Policy Advisor
- Develop, implement and/or supervise all department policy and procedures
- Act as liaison between local and federal network and all contracted physician providers, ancillary providers, and facilities.
- Provides management, direction and resource coordination for Medical Management.
- Provide support to all clinical personnel (such as nurses & physicians) and Program Directors in order to maintain current knowledge in the fields of Case Management, Disease Management, Credentialing and Quality Management, and Utilization and Medical Management
- Participates on interdepartmental teams for the purpose of improving efficiency, solving operational problems and developing or implementing new systems
Clinical Compliance Goals for 2007
Senior Citizen Affairs[A] Data Infrastructure System
- Identify the Current Data Collection Process
- Develop a Project Overview
- Proposal Development(RFP)
- Understanding Application Domain
- Submitting Proposal and Establishing Collaboration
- Develop policies related to chronic disease
- Revise and implement chronic disease tools
- Provide educational seminars and lectures on the treatment and prevention of chronic disease within the senior programs
- Educate seniors about health topics through various media avenues and local publications concerning various chronic diseases such as diabetes, depression, heart failure and hypertension
- Provide Pharmacotherapy expertise to Administrators and Directors as it relates to the Medicare Modernization Act of 2006
- Assist the SPAP staff as it relates to formulary concerns and/or recommendations
- Providing education seminars or workshops on disease state management and medication topics to SPAP staff and/or seniors
- Design a DHS Formulary within the SPAP Program
- Collaborate with Medicare Pharmaceutical Providers and locals pharmacies to assure patient compliance to drug regimens Adult Protective Services
- Provide assistance in establishing of policies and protocols
- Provide clinical and medication management training
Children Youth & Family
- Collaborate with program Directors and administrators in complying , coordinating, and monitoring of reporting clinical outcomes all assigned local and federal grants
- Ensure quality and timely responses of all CYF clinical functions and monitor its performance outcomes.
- Provide pharmacotherapy sessions to clinical staff (including probation officers) and families
- Assist in revising and supporting clinical policies and documentation related to contracting for service
- Assist in the development and implementation of technical assistance strategies for CYF to address their programmatic and administrative needs and to help ensure contract compliance and quality programs