Compliance/Operations Director

About Santa Cruz Community Health

Santa Cruz Community Health (SCCH) began as a women's health collective in 1974 and today is a nonprofit Federally Qualified Health Center operating two sites: the Santa Cruz Women's Health Center in downtown Santa Cruz and the East Cliff Family Health Center in Live Oak. SCCH serves a diverse patient population in an engaging, friendly, team-based work environment committed to comprehensive, quality health care.

Position Summary

The Compliance/Operations Director (COD) is a key leader overseeing non-clinical aspects of the agency's compliance with local, state, and federal mandates and guiding SCCH operations, with the overarching goal of delivering accessible, high-quality, patient-centered care. The COD works closely with the Quality Improvement Director (QID) and Quality Assurance Director (QAD) and supports the Chief Operating Officer (COO), Leadership Team, and Board of Directors in upholding the compliance function for the entire agency. The COD catalogs local, state, and federal mandates and puts systems in place to ensure compliance, and is a key participant in new ventures such as clinic expansions and new clinic starts. The position reports to the COO.

Classification: Full-time, Exempt | Reports to: COO | Location: Varies | Hours: 8:00AM-5:00PM (flexible)

Core Job Responsibilities

Compliance

• Supports and models SCCH's culture of safety and compliance; onboards new hires into this culture.
• Works within each SCCH department to understand and comply with the 7 standard elements of compliance programs, including written policies and procedures, designating a compliance officer/committee, training and education, effective lines of communication, internal monitoring and auditing, well-publicized audit results and guidelines, and prompt corrective action for detected exceptions.
• Prepares all departments for HRSA operational site audits and Joint Commission site visits.
• Leads the development, implementation, and ongoing oversight of activities related to healthcare compliance laws and regulations, including healthcare fraud and abuse, privacy, transparency reporting laws, the Federal Anti-Kickback Statute, the Federal False Claims Act, and HIPAA.
• In conjunction with COO, QID, and QAD, designs and executes internal reviews and risk assessments to identify and correct compliance risks.
• Monitors and audits to ensure compliance policies and procedures are followed; trains and supports staff and management in identifying and resolving exceptions.
• Partners with internal (e.g., HR) and external stakeholders to conduct investigations and resolve potential compliance breaches; manages corrective action plans.
• Provides regular compliance reports and presentations to internal audiences, including Leadership Team and Board of Directors; serves as internal expert on challenging medical records questions.

Facilities and Licensing

• Assists operational and quality teams with external audits, including preparation, attendance, and follow-up (external bodies include VFC/VFA, CCAH, CPSP, CHDP, Beacon, and others).
• Assists HR department and QAD to prepare SCCH's future FTCA application.

Direct Operations

• Actively participates in the Operations Leadership Team.
• Under direction of the COO, works closely with Leadership Team, Operations Leadership, and other stakeholders to implement programs, refine workflows, and improve service delivery systems.
• Provides support to and, as necessary, backfills other members of Operations Leadership (Clinical Support Managers and Patient Support Manager) when absences affect day-to-day patient care.
• Participates in the development of training strategies to improve staff understanding and adherence to compliance procedures; provides teaching, coaching, and guidance to the Operations team.

Committee Participation; Additional Duties

• With support from QA/QI staff, manages the PolicyTech system (SCCH policy and procedure database), including onboarding new staff, troubleshooting, and ongoing support; acts as PolicyTech champion.
• In consultation with COO, determines the need for new non-clinical policies and manages reviews and approvals within PolicyTech.
• Acts as a leading member of the QA/QI Committee; convenes and facilitates the Operational Risk Management Committee (ORM) in partnership with COO.
• Participates in other internal committees: Privacy & Security, Clinical Risk Management (CRM), Human Resources Risk Management (HRRM), Physical Safety, and Immunization Workgroup.
• Receives, investigates, and responds to applicable incident reports, complaints/grievances from the managed care plan, and escalated operational complaints, reviewing with COO and clinic-based staff.
• Other duties as assigned.

Qualifications

Minimum Requirements:

• BA/BS in Healthcare administration or related field.
• 5+ years of progressively responsible experience in a health care setting.
• Experience and skill with Electronic Medical Records.
• Demonstrated experience and success with healthcare compliance activities and projects.
• Demonstrated understanding of healthcare compliance rules and regulations, and experience in the practical application of local, state, and federal mandates, including audit experience.
• Certification in Healthcare Compliance (CHC), Healthcare Privacy Compliance (HCPC), or equivalent; or commitment to attain within 6 months of hire.

Preferred Qualifications:

• Master's Degree in public health, business management, or public administration.
• Experience in an FQHC (Federally Qualified Health Center) or equivalent strongly preferred.
• Privacy officer experience preferred.

Salary and Benefits

Competitive compensation and benefits package available to staff working at least 20 hours per week. Paid time off and paid holidays accrue from date of hire. Employer-subsidized group health, dental, vision, and life insurance plans begin the first of the month after 30 days of employment. Automatic 2% enrollment in an employer-sponsored 401K plan with a 2% retirement match.

Santa Cruz Community Health is an Equal Opportunity Employer (W/M/V/D).