Vice President, Audit and Compliance
Are you excited to step into a complex world that requires a blend of mind, heart and flexibility? We at CareOregon have been strengthening communities since 1994 by making health care work for everyone. As a nonprofit health plan largely focused on Oregon’s Medicaid population, we find fulfillment in supporting the underserved.
General Statement of Duties
This position is responsible for leading audit, compliance and risk management functions across the organization, reinforcing a strong culture of enterprise-wide compliance, privacy, security and risk mitigation. Core responsibilities include technical leadership and strategic planning, as well as development and oversight of resources, relationships, and successful teams. This position acts as a collaborative resource with respect to compliance, privacy, security, and risk issues. This position serves as CareOregon’s Compliance Officer, functioning independently and reporting directly to both the CareOregon CEO and the Boards of Directors. Additionally, this position provides routine compliance and enterprise risk monitoring and reporting to CareOregon affiliates and subsidiaries to include their corresponding management and oversight bodies.
Essential Position Functions
Provides strategic leadership for audit and compliance activities across the organization in support of the Medicaid, Medicare, and other populations and in compliance with the Centers for Medicare & Medicaid Services (CMS) and the Oregon Health Authority (OHA).
Ensures the internal audit function applies a systematic and disciplined approach to evaluating the effectiveness of operational quality control, compliance, and governance processes.
Oversees the regulatory audit function and serves as an effective bridge between the business and regulatory agencies, managing communications and assisting the business in meeting the requirements of state and federal regulators.
Ensures compliance operations function effectively, oversees contractually required reports and ensures documentation in a centralized location, and routinely monitors compliance with contractual service level agreements.
Develops and continually monitors and evaluates the Compliance and Risk Management Programs, working collaboratively across the organization to identify and remediate areas of risk.
Oversees the delegation oversight function in ensuring large subcontractors meet the requirements to receive delegated functions.
Ensures the regulatory compliance function effectively manages compliance processes from intake, interpretation, solution implementation, to compliance operations handoff. Ensure proper reporting of violations or potential violations as appropriate and required.
Develops, implements, and oversees healthcare compliance and privacy training and communications strategies, plans, content, and associated materials; develop metrics to determine effectiveness of training program.
Identifies compliance and risk management performance metrics; ensures the timely and accurate monitoring and reporting of performance against metrics.
Ensures HIPAA and 42 CFR Part 2 privacy and security related laws, rules and guidelines are effectively adhered to.
Ensures effective monitoring, reporting, and investigating of suspected Fraud, Waste and Abuse (FWA), and the implementation of timely corrective actions.
Reports status of compliance program effectiveness to the CEO, key executives, and the Board committees responsible for Compliance oversight; coordinates with federal and state regulators.
Acts as a resource, internal consultant, and educator for compliance, privacy, regulatory and risk management issues; may serve as a sponsor for key projects and initiatives.
Leads the development of vision and goals for the audit and compliance functions.
Develops and refines strategic plans, including risk assessments, compliance plans, and risk management plans, in alignment with organizational vision and goals.
Defines operational structure for areas of oversight and approves policies.
Participates in the strategic planning process for the organization.
Maintains an enterprise view while establishing business unit priorities.
Develops budgets in alignment with strategic planning.
Ensures teams have sufficient resources to perform their work.
Ensures budgets are monitored and managed effectively across areas of oversight.
Approves resource allocations within budget, including people, finances, and timelines; makes decisions on exceptions.
Ensures strategic messages are regularly and effectively relayed to management team and staff; promotes transparency.
Leverages current relationships and forges and leverages new relationships with community partners, vendors, and other constituents in alignment with organizational direction and priorities.
Collaborates with leaders across the organization in identifying integrated improvement strategies and ensuring meaningful integration.
Represents the organization in external meetings and functions, providing strong leadership presence and effectiveness.
Directs teams and establishes team and management direction and goals.
Provides team members with ongoing understanding of the strategic direction of the organization.
Performs employment functions in collaboration with Human Resources, including staffing, recruitment, performance management, professional development, and termination.
Coaches, inspires, and recognizes staff.
Creates opportunities for professional development.
Promotes participation in training initiatives and organizational activities, as well as adherence to external regulations and internal policies.
Fosters a culture of success in alignment with the organizational mission, vision, and values.
Essential Organizational Functions
Supports and operates in alignment with the organization’s core values.
Strives to meet work goals that contribute to departmental and organizational goals.
Adheres to organizational standards, policies and procedures, as well as compliance requirements.
Performs other duties as assigned.
Technical Knowledge, Skills and Abilities Required
Strong understanding of managed healthcare operations
Understanding of State and Federal compliance plan requirements for Medicaid (and preferably Medicare)
Knowledge of HIPAA Privacy and Security laws, practices, access, release information and release control technologies
Knowledge of the Patient Protection and Affordable Care Act
Knowledge of OAR’s and their purpose
Thorough knowledge of accounting practices/procedures and internal controls
Understanding of, and adherence to, the Auditors Code of Ethics and the Standards for the Professional Practice of Internal Auditing as developed by the Institute of Internal Auditors
Basic understanding of information systems
Understanding of contract law and maintenance of policies and procedures related to contracts entered into by corporate officers
Ability to perform or oversee the performance of risk assessments and/or gap analysis
Strategic leadership skills, including the ability to effectively guide the organization in the areas of audit, compliance, and risk management
Ability to build, oversee, and motivate teams
Excellent written and verbal communication skills, including presentation skills
Ability to think logically and creatively without undue influence from personal biases
Ability to build conceptual models, communicate complex ideas effectively, and drive change
Ability to serve in an internal consulting role to organizational leadership
Physical Skills and Abilities Required
Lifting/Carrying up to 0 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
Reaching Above Shoulders
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
Cognitive and Other Skills and Abilities Required
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.
Education and/or Experience
Minimum 10 years’ experience in audit and/or compliance, including experience in Medicaid compliance
Minimum 5 years’ experience managing people
Management experience in Medicaid and Medicare compliance
College degree in Business, Health Care Administration, Law, or related field
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
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
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.