​​​​​​ABOUT SHERIDAN MEMORIAL HOSPITAL

At Sheridan Memorial Hospital, we are proud to have achieved the 5-Star Quality Rating, ranking us in the top 13.6% of hospitals rated by the Centers for Medicare and Medicaid Services. We believe that our ability to deliver excellent healthcare begins with our people, and we are proud of our more than 750 skilled, experienced, and caring employees. We have over 100 providers who specialize in 25 areas of expertise. Our facility is state-of-the-art, and we are dedicated to providing outstanding patient-centered care. Nestled at the foothills of the Big Horn Mountains in northern Wyoming, spectacular scenery and outdoor activities abound. Our hospital has the latest technology and equipment comparative to that of many larger facilities, and you will find our staff are friendly, compassionate, caring, and courteous. We focus on creating and nurturing a workplace that encourages, recognizes, and rewards individual effort and creativity. Leadership is responsive to changing modes of healthcare delivery and adapts accordingly. We value effective communication and honesty and believe teamwork based on mutual respect is key to success.

JOB SUMMARY The Compliance and Privacy Officer (CO) is to be a proactive agent to lead the Organizational Compliance effort at Sheridan Memorial Hospital (SMH), ensuring management and personnel are complying with the organizational policies and procedures, as well as applicable laws and regulations. As such, the CO will report to the Chief Executive Officer and Board of Trustees Compliance Committee. The CO will be the facility expert and “go-to” person in all areas of healthcare Compliance for all hospital staff and medical staff, will actively monitor and review SMH work processes and look for opportunities to improve our Compliance efforts, will report the results of those efforts to the Compliance Committees with recommendations and guidance on how to improve our Compliance efforts and adapt to changes in Compliance regulations, will provide training to hospital staff and medical staff on matters of Compliance that will affect their roles at SMH, will be THE visible leader and key change agent for all areas of Compliance in SMH and all its divisions. ESSENTIAL JOB FUNCTIONS

• Works with management and leadership to identify potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.

• Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and resolved.

• Monitors, and as necessary, coordinate compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.

• Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.

• Establishes and provides direction and management of the compliance Hotline.

• Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct. Manages day-to-day operation of the Program.

• Develops and periodically reviews and updates Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.

• Collaborates with other departments to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with the hospital attorney as needed to resolve difficult legal compliance issues.

• Responds to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations.

• Provides reports on a regular basis, and as directed or requested, to keep the board of Trustee Compliance Committees and senior management informed of the operation and progress of compliance efforts.

• Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.

• Works with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.

• Monitor the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness.

Leadership and Human Resource Management

Demonstrates consistent leadership performance and behavior by actively being engaged in making SMH/BHHN a five-star provider of quality care by being a positive force within the organization and actively promoting teamwork and harmony. Delegates effectively and supervise follow-through. Persuasive, fair, impartial, sets high standards, and ensures clear focus and direction. Achieves desired results with support, confidence and integrity. Regularly recognizes achievements of others. Leads others to success, supporting individual and team accomplishments.

Supervisory duties and responsibilities include:

• Writes and conducts annual performance appraisals and ensures regular ongoing feedback, coaching, and communication with staff.

• Ensures a high level of performance standards and achievement to meet organizational needs and business goals.

• Provides development opportunities for staff to broaden and enhance their skills and abilities.

• Administers organization policies and procedures.

• Ensures compliance with safety policies and good housekeeping.

• Manages initial training of new employees and ongoing training as required.

• Promotes an environment that fosters teamwork and commitment to satisfy customer requirements.

Disclaimer: The above description has been designed to indicate the general nature of work performed within this position.

MINIMUM REQUIREMENTS Education / Experience / License and Certifications

• Minimum of 3 years supervisory experience, preferred.

• Bachelor’s degree required, Master’s degree preferred.

• Thorough knowledge of Healthcare Compliance and familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must.

• Minimum of 3 years of related experience, preferred.

• Must attain and maintain CHC certification through the Health Care Compliance Association.

Additional Skills

• Clinical healthcare experience preferred.

• Working knowledge of computer systems.

• Maintains confidential information.

• Able to multitask with phones and customers.

• Must have excellent customer service and communication skills.

  Specific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products.

Pre-employment drug and alcohol screening is required.

Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status. If you would like more information about your EEO rights as an applicant under the law, please click here (http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf) .