Vice President, Corporate Compliance

Role & Responsibility
· Assist the organization in achieving responsible and effective corporate (risk management) and compliance programs
· Formulates an organization-wide integrated and holistic approach to governance, risk and compliance including strategy, processes, technology and people
· Proactively identify major risk events
· Perform risk assessments and compliance investigations
· Coordinates Ethics & Compliance hotline
· Monitors key compliance risk areas and may engage outside services for compliance audits
· Ensure that improvement opportunities and problems identified through auditing and monitoring have been addressed through effective follow up mechanisms including management accountability and remedial action
· Maintain current knowledge of laws and regulations
· Establish policies and procedures to maintain compliance
· Educate on compliance program, policies & procedures and communicate awareness
· Monitor compliance with laws, regulations, policies and procedures
· Responds to all concerns reported to compliance functions and hotline
· Recruit and develop key staff
· Serves as Chair, Compliance Committee and Vice Chair, ERM Committee
· Serves as HIPAA Privacy Officer
· Ensure effective staff compliance training program
· Responsible for CIA, IRO, OIG, investigations hotline and training (including 7 elements)
• Perform any other job related instructions as requested, with reasonable accommodation

Key Decision Rights
· Development of compliance policies and procedures
· Annual risk and compliance plan
· Hiring of Staff
• Conduct and authorize investigations, in conjunction with Legal

Cross Functional Interactions
· Interact with internal departments, such as Government Affairs, Legal, IT, Finance, Quality, EPM, Markets

· Perform duties as established in Board approved program or charter
· Effectiveness and efficiency of operations
· Reliability of financial reporting
· Compliance with applicable laws and regulations
· Ensures auditing and monitoring of key compliance risk area
· Provides necessary compliance controls relative to IT system implementations and controls
· Ensures proper HIPAA privacy and security controls
• Ethically correct behavior, improved efficiency, improve effectiveness thru insuring operations is managed and supported through the GRC

Required Education / Experience
· Bachelor of science degree in business administration, healthcare administration or related discipline is or equivalent work experience is required
• Master’s in Business Administration, Healthcare Administration and/or other related discipline is preferred
• Seven or more years of compliance or related experience is required
• Senior Executive Leadership experience with a managed care organization or related industry

Required Competencies / Knowledge / Skills
· Strong working knowledge of compliance theory, practices, laws, regulations, guidelines and professional standards
· Depth in governmental product design and experience working with underserved populations
· Understanding of Medicare/Medicaid regulatory requirements
· Strong understanding of healthcare finances
· Knowledgeable of HCCA, AHIA, COSO
· Commitment to the mission and values of the CareSource Family of Companies
· Strong collaborative skills, working with cross-functional stakeholders and external partners including state and federal regulators
· Effective communication and presentation skills

Licensure / Certifications
• Certified in Health Care Compliance (CHC) is preferred

Working Conditions
• General office environment

Position Description »