Director, Compliance

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Job Summary
This position is responsible for leading the execution of Medicaid and Medicare compliance strategy and activity across the organization. Primary duties include technical and operational planning and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization.

Essential Responsibilities

Technical/Operational Leadership

In coordination with the VP of Audit and Compliance, directs compliance activities across the organization in support of Medicaid, Medicare, and other populations.
Ensures the development and operation of an effective compliance program in accordance with CMS requirements and the Federal Sentencing Guidelines, including:
Monitoring to ensure effective written compliance policies and procedures and Standards of Conduct
Periodic reporting to the organization’s Internal Compliance Committee (senior management) and governing Board of Directors; serve as the Internal Compliance Committee Chair
Providing effective training and education
Establishing and maintaining effective lines of communication at all levels of the organization (to include a non-compliance reporting hotline)
Ensuring consistent enforcement of well-publicized disciplinary standards
Developing and maintaining an effective system for routine monitoring, auditing and identification of compliance risks
Collaborating with other departments to direct compliance issues to appropriate existing channels for investigation and resolution; consults with external attorneys as needed to resolve difficult legal compliance issues
Ensuring there are clear and specific disciplinary policies, procedures and standards
Develops and monitors an annual compliance work plan.
Reviews and leads the implementation of new requirements outlined by CMS and OHA
Acts as the primary leader to plan all meetings with external regulatory sources and oversees the organizational compliance calendar
Ensures the development of sufficient and accurate compliance dashboards used to identify and monitor current compliance and compliance trending of all operational activities.
Identifies 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.
Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
Provides oversight of the development and maintenance of policies, procedures, structures and training to support the staff and department into the future.
May serve as a sponsor or chair for key projects and initiatives.

Strategic/Operational Planning

Participates in the development of vision, goals, and strategic plans for Audit and Compliance.
Provides input into the strategic plans of the organization.
Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.
Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

Recommends budgets in alignment with short and long term plans.
Manages resources to ensure priorities are accomplished.
Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.

Relationship Management

Leads effective communication system for work group(s), ensuring a collaborative culture.
Builds and ensures effective relationships across internal teams and external organizations for current or future integration.
Partners with internal leaders and managers in identifying improvement plans and processes.
Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.

Supervision

Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
Identifies department priorities; ensures employees have information and resources to meet job expectations.
Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
Manages, coaches, motivates, and guides employees; promotes employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
Ensures team adheres to department and organizational standards, policies, and procedures.
Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
Performs supervisory tasks in collaboration with Human Resources as needed.

Education and/or Experience

Required:

Minimum 10 years’ experience in regulatory, compliance, and/or audit, including at least 8 years’ experience in healthcare
Minimum 4 years’ experience in a supervisory position
Preferred:

Leadership experience in a managed care organization

Working Conditions

Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes

☐ Other_________________________________________

Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Position Description »