Crystal Wells
Saint Petersburg,FL
Summary
Knowledgeable Risk Manager equipped with strategic planning and program leadership abilities honed in the healthcare industry environments. Establishes strong and successful policies to mitigate risk at each level and establish clear procedures for assessments, prevention and containment. Familiar with regulatory requirements to maintain strict controls.
Overview
6
6
years of professional experience
1
1
Certificate
Work History
Risk Manager
EVARA Health, Community Health Centers of Pinellas
Saint Petersburg, FL
09.2020 - Current
- Monitors and evaluates patient care activities to identify trends and opportunities for improvement
- Generates and/or coordinates the development of various reports regarding risk including trends, high volume, high risk and outcome data
- Develops, plans, coordinates and presents specific trainings and educational programs as appropriate to the risk management needs of the organization or employee
- Collaborates with employee health nurse and HR to monitor employee exposure incidents with appropriate action
- Reports on risk management activities in designated committees and via regular communication with
- CMO, CEO and Quality Improvement team; follows-up on recommendations and corrective actions Risk
- Developed short-term goals and long-term strategic plans to improve risk control and mitigation.
- Advised senior managers on policy strategies for reducing liability and preventing losses.
- Reviewed contracts and agreements to identify potential risks and ideal mitigation strategies.
- Investigated allegations to check validity and recommend actions to minimize risk.
- Kept operations in compliance with OSHA, state and federal regulations through regular safety inspections and hazards management strategies.
- Promoted enterprise-level risk management practices and helped instill strong culture focused on protective policies and procedures.
- Taught employees how to control risks at front line.
- Handled FTCA claims according to internal risk management policies, keeping liability minimized by leveraging expertise and available tools.
- Employed strong program management skills to successfully define and manage ongoing initiatives designed to control Healthcare risks.
- Encouraged stakeholders to approach assessments analytically and offer unique insights to bring new understanding to risk management programs.
- Performed in-depth research and investigations and recommended strategies to resolve problems and prevent further concerns.
- Implemented financial risk management policies, limits and strategies that complied with standards and strategic imperatives of organization.
- Monitored industry, technological and economic developments to stay current on potential risks.
- Completed statistical reviews to uncover trends, patterns and variations.
- Developed short-term goals and long-term strategic plans to improve risk control and mitigation
Facility Compliance Officer
Bayfront Health St
Saint Petersburg, FL
11.2019 - 09.2020
- Implement the Corporate Compliance and Privacy Program for the FCOs/FPO’s Affiliate
- Personally present compliance and privacy training at the Affiliate’s new hire orientation
- Promote an environment in which employees are free to confidentially report instances of non-compliance without fear of retribution
- Interact regularly with and report to the CCD or CCO regarding the organization’s compliance-related activities, including training, auditing, disciplinary actions, and corrective actions taken in response to reports of alleged non-compliance
- Notify the CCD and CCO of any contact from a government agency (i.e., OCR, OIG, FBI, etc.)
- Audit and monitor user access activity of Electronic Medical Record system(s) for user activity occurring outside the scope of a user’s authorized access and job duties
- Assist the Contract Administrator with determining whether a contract requires a Business Associate
- Agreement (“BAA”), and ensures facility-level BAAs are maintained in accordance with the Document and Record Retention Policy and Schedule and the
- Business Associate Agreement Requirements Policy
- Maintain an awareness of current laws, statutes, and regulations that impact healthcare operations and physician transactions and relationships
- Review and coordinate communication, distribution, and implementation of new and revised Corporate
- Compliance policies and procedures
- Recommend additional policies and/or policy revisions, as necessary
- Assist with the development and implementation of corrective action plans when areas of noncompliance are identified
- Attend Corporate-led educational events and regularly scheduled Conference Calls/Webinars for
- Compliance and Privacy topics
- Establish a facility-specific annual compliance audit plan in conjunction with the CCD
- Collaborate with Human Resources and all Department Directors to ensure all relevant staff complete new hire and annual compliance and privacy training, and all training is appropriately documented
- Facilitate the Compliance auditing and monitoring plans to determine compliance with established laws, regulations, company policies, and managerial guidelines
- Report all results to the FCC and immediately notifies the CCD of adverse outcomes
- Report current and ongoing privacy issues to the FCC
- Conduct regularly scheduled Data Privacy & Security Monthly Walk-Through assessments of various departments throughout the Affiliate’s facility and other business units to monitor adherence to privacy regulations and submits the assessment results via a report to
- Facility Compliance committee
- Conduct focused compliance audits on topics of concern as directed or approved by Corporate
- Compliance
- Chair the Facility Compliance Committee (“FCC”); ensure adherence to the standard agendas for each
- FCC meeting, and prepares FCC minutes
- The Dedicated FCO also:Add agenda elements as needed at the entity level to ensure adequate and appropriate coverage of facility-specific compliance issues or concerns
- Hold regular FCC meetings (monthly for hospitals; quarterly for ASCs and Large Clinic Organization);
- Ensure adherence to the corporate standard agendas for each meeting of the FCC;
- Prepare and report minutes of the FCC meetings to the FCC and Corporate Compliance as required by the standard FCC Guidance Document;
- Develop oral and written reports, including recommendations for improvement or corrective actions based upon audit and investigative findings;
- Ensure adequate and complete follow through on potential risk areas to demonstrate appropriate actions were taken to remediate risks;
- Work with appropriate business partners to implement and document all corrective action plans identified during the course of auditing and monitoring activities;
- Add FCC agenda elements, as needed, at the facility level to ensure adequate and appropriate coverage of facility specific compliance issues or concerns;
- Collaborate with department directors to improve timely identification of compliance variances
- Conduct and thoroughly document compliance and privacy investigations under the guidance of the assigned Corporate Compliance Director (“CCD”)
- Communicate immediately with the assigned CCD or CCO upon learning of a matter of potential concern or upon receiving an allegation of non-compliance, including privacy complaints and matters
- Enter all reported incidents of known or suspected noncompliance into the Compliance 360 (“C360”) incident tracking system
- Maintain timely and thorough documentation and status updates in the system to ensure complete documentation of all reported concerns including training, auditing, disciplinary actions, investigation steps, and corrective actions taken in response to reports of alleged noncompliance
- Work with assigned the CCD, Legal, HIM, and other key departments and committees to ensure the organization maintains appropriate privacy and confidentiality consent and/or authorization forms, notices, and materials reflecting current organizational and legal practices and requirements
- Collaborate with the HIM Director and other applicable staff to ensure patient rights to request access, amendment, accounting of disclosures, restrictions, and confidential communications of protected health information, when appropriate
- Dedicated Facility Compliance and Privacy Officer Description of Duties June 10, 2020
- Facilitate patient receipt of the Notice of Privacy Practices in registration areas, owned physician practices, and in other business units
- Serve as the subject matter expert on privacy for all departments and business units in conjunction with the facility HIM Director, Corporate Compliance and Privacy, and
- Corporate Health Informatics & Information Management, on topics such as disclosures to law enforcement, news media, social media, substance use disorder treatment records, etc
- Coordinate with the Director of Information Systems to ensure HIPAA Security standards are implemented and maintained
- Ensure implementation of a process for conducting eligibility screening of all relevant persons; coordinates with Human Resources, Medical Staff Development, Patient
- Financial Services, and Contract Administration to ensure complete assessment of all required parties through the use of the ExclusionCheck eligibility screening product
- Implement and maintain the Document and Record Retention policy including the destruction guidelines for the facility and affiliated entities
- Conduct ongoing reviews of Focus Arrangements (“FA”) for the Affiliate using Ariba and other resource materials found on the Corporate Compliance Focus Arrangements intranet webpage, to determine the completeness of all FA documentation in Ariba, and for the validity of payments to FAs
- Documents the findings in the C360 FA audit tool and notifies the CCD of significant exceptions
- (Task not applicable to Shared Service Centers,
- Ambulatory Surgery Centers, or Large Clinic Organizations.)
- Other duties as assigned by the Chief Executive Officer of the facility, or the Senior Vice President,
- Corporate Compliance and Privacy Officer.
- Liaised with risk management, internal audit and employee services departments to direct compliance issues to appropriate channels for investigation and resolution.
- Managed practical action plans to respond to audit discoveries and compliance violations.
- Implemented improvement initiatives and developed compliance testing program to monitor and identify gaps in new and existing practices.
- Identified potential areas of compliance vulnerability and risk to develop and implement corrective action plans.
- Gathered, organized and evaluated data to make accurate assessments of current operations.
- Monitored compliance with processes, policies, procedures and standards in regards to collection and management of annual contributions from shareholder companies.
- Wrote and presented reports outlining findings and recommendations from compliance audits.
- Enhanced regulatory, strategic and operational performance to keep in alignment with deadlines.
- Improved company policies and standards to outline ethical, safe and efficient procedures.
- Prepared training programs to improve compliance at all levels.
- Provided guidance, advice and training to improve business' understanding of related laws and regulatory requirements.
- Reviewed contracts for compliance and privacy-related issues.
- Counseled committees and department heads regarding compliance risks and standards.
- Oversaw proper maintenance and dissemination of filing documentation as well as records and reports for review by various departments.
- Reviewed company forms, marketing materials and communication procedures for compliance with applicable laws and guidelines.
- Monitored data export from internal and external systems, identifying and reporting potential risks.
- Created policies and programs to encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation.
- Established and cultivated productive relationships with regulatory bodies.
- Developed and implemented internal control tests to verify employee compliance with established policies and procedures.
- Improved collection process via solicitation and analysis of feedback as well as detailed reporting.
- Oversaw and monitored violation tracking system for accuracy, which reduced HIPAA issues by more than 50%.
Risk Manager
Bayfront Health St. Petersburg
St. Petersburg, Florida
10.2018 - 09.2020
- Developed short-term goals and long-term strategic plans to improve risk control and mitigation.
- Advised senior managers on policy strategies for reducing liability and preventing losses.
- Reviewed contracts and agreements to identify potential risks and ideal mitigation strategies.
- Investigated allegations to check validity and recommend actions to minimize risk.
- Kept operations in compliance with OSHA, state and federal regulations through regular safety inspections and hazards management strategies.
- Promoted enterprise-level risk management practices and helped instill strong culture focused on protective policies and procedures.
- Taught employees how to control risks at front line.
- Handled over 50 claims according to internal risk management policies, keeping liability minimized by leveraging expertise and available tools.
- Employed strong program management skills to successfully define and manage ongoing initiatives designed to control Healthcare risks.
- Analyzed impact of environmental disasters to physical data centers and create and implement response plans.
- Performed in-depth research and investigations and recommended strategies to resolve problems and prevent further concerns.
- Produced and filed reports every quarterly to inform senior management of current activities and progress with investigations.
- Worked within risk reduction & occurrence reporting software to compile and review information with pivot tables and charts.
- Coordinated ongoing efforts to strengthen risk culture and fine-tuned risk appetite for lending and funding activities.
Director of Quality Assurance
Palm Garden Of Pinellas
Largo, Florida
01.2018 - 10.2018
- Drafted internal QA policies on factors such as design controls, product realization activities, validation techniques and more.
- Authored documentation for internal use by QA personnel, setting guidelines for review activities and reporting requirements.
- Interfaced directly with high-level executives within client companies, addressing concerns and correcting perceived faults to maintain smooth customer relationships.
- Directed quality assurance teams, shortened validation turnaround times and reduced customer complaints.
- Oversaw QA operational activities such as sampling, inspection and line monitoring, verifying compliance with prescribed fault rates and tolerance goals.
- Enforced compliance with government regulations and company policies.
- Developed and maintained records of policies, procedures and best practices to support continuous improvement for the healthcare industry.
- Developed and maintained records of policies, procedures and best practices to support continuous improvement for the healthcare industry.
- Determined quality department standards, practices and procedures.
- Established and tracked quality department goals and objectives.
- Applied coaching techniques and tools to support managers and team members in improving performance.
- Monitored staff organization and suggested improvements to daily functionality.
- Scheduled and chaired quality review meetings to review effectiveness of performance mitigating risk, improving throughput and achieving customer satisfaction.
- Implemented new quality assurance and customer service standards.
- Inspected products and worker progress throughout production.
- Collaborated with audit clients and action owners to apply root cause analysis guidance and establish effective corrective action plans.
- Tracked quality issues with external customers, suppliers and internal plant operations.
- Assured consistent quality of production by implementing and enforcing automated practice systems.
- Developed quality planning for multiple new product launches by verifying customer requirements and implementing in design and production.
- Evaluated interactions between associates and customers to assess personnel performance and implement strategies for customer satisfaction improvement.
Nursing Unit Manager
RN
Clearwater, FL
06.2017 - 12.2017
- Assisted in development and implementation of policies, procedures and regulations for unit operations.
- Handled complaints from patients and families and immediately took steps for quick resolution and to prevent reoccurrence.
- Oversaw RNs, LPNs, nursing aides, medical clerks and support staff and performed staffing scheduling duties.
- Met with nursing staff and support personnel to plan services, programs and activities.
- Promoted patient independence by establishing patient care goals and taught and counseled patients, friends, and family about medications and self-care skills.
- Coordinated nursing with other services to promote continuity of total regimen of care.
- Maintained adequate stock of medications, supplies and equipment to meet patient needs.
- Protected patients and employees by developing and interpreting infection-control policies and protocols and maintained patient confidence by monitoring confidential information.
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees.
- Developed and updated policies and procedures, maintaining compliance with statutory, regulatory and local, state and federal guidelines relating to HIPAA, benefits administration and general liability.
- Communicated with patients, ensuring that medical information was kept private.
- Direct day-to-day administrative and operational functions for 120-bed facility, providing guidance and leadership to over 40 employees across more than 4 departments.
- Fostered excellence by example by "setting pace" and being hands on mentor to clinical staff.
- Conducted routine facility inspections, identifying areas needing improvement and eliminating hazards posed to staff and residents for continued compliance with associated regulations.
- Created customized care plans, working with hospital staff and families to assess and meet individual needs.
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
- Monitored and inspected staff processes to eliminate hazards posed for both residents and staff while ensuring continuous compliance with regulations.
- Motivated and supervised 40 LPN's, and CNA in delivering quality patient care.
- Recruited, hired and coached employees to offer high-quality, cost-effective care to all residents.
- Ordered all pharmacy supplies and kept check on inventory levels.
- Discussed medical histories with patients in effort to provide most effective medical advice.
- Reviewed and evaluated test results to suggest care and treatment options.
ADON
RN, GOLFVIEW, ADON
Saint Petersburg, FL
04.2017 - 06.2017
- Responsible for interviewing, recruiting and evaluating nursing staff personnel
- Eliminated agency use resulting in a saving of over $15K/month
- Scheduled over 130 employees monthly maintaining daily PPD's
- Developed skin and weight management policies and procedures
- Coordinated Medicare utilization and chaired weekly utilization meetings
- Responsible for professional nursing care of ventilator/trachea patients
- Supervised Nursing Assistants providing daily resident care
- Supervised Nursing staff
- Assisted in decreasing falls, psychotropic medication use, and other quality measures
- Performed daily job duties and filled in when needed
- Managed multiple programs with success including bowel and bladder, restorative, infection control, fall tracking and trending, MDS audits, skilled program, admission process
- Ensured Resident care-plans contained accurate documentation
- Coordinated efforts to enhance the services provided to the residents i.e
- Physical therapy, durable medical equipment, etc
- Assisted nursing staff in observing for Significant Changes, documenting and reporting as necessary
- Managed staff of 25 LPNs 15 registered/licensed nurses and 40 nursing assistants
- Education Instruction: Hired and trained nurses in home medical patient care and regulations
Education
CPHRM - Risk Management
University of Florida
01.2019
AS - Nursing
SPC
12.2016
ALF Administrator in Administration -
St. Petersburg College
06.2016
LPN-Nursing - Nursing Practice
PTECH-PINELLAS
Clearwater, FL11.2014
Associate of Arts - General Studies
SPCollege
Saint Petersburg 08.2010
Skills
- Corrective Actions
- Government Regulations
- Insurance Requirements
- Risk Identification
- Legal Research
- Crisis Prevention Intervention
- Trend Analysis
- Root Cause Analysis
- Data analysis
- Risk mitigation
- Claim Reviews
- Employee Safety
- Conducting investigations
Certification
- CPHRM- Certified Professional in Healthcare Risk Management.
Timeline
Risk Manager
EVARA Health, Community Health Centers of Pinellas
09.2020 - Current
Facility Compliance Officer
Bayfront Health St
11.2019 - 09.2020
Risk Manager
Bayfront Health St. Petersburg
10.2018 - 09.2020
Director of Quality Assurance
Palm Garden Of Pinellas
01.2018 - 10.2018
Nursing Unit Manager
RN
06.2017 - 12.2017
ADON
RN, GOLFVIEW, ADON
04.2017 - 06.2017
CPHRM - Risk Management
University of Florida
AS - Nursing
SPC
ALF Administrator in Administration -
St. Petersburg College
LPN-Nursing - Nursing Practice
PTECH-PINELLAS
Associate of Arts - General Studies
SPCollege
- CPHRM- Certified Professional in Healthcare Risk Management.
Listening to Audible books
Audible books is my way of escaping into another world. It relaxes me after a long day.
Listening to Audible books
Audible books is my way of escaping into another world. It relaxes me after a long day.