Job Description

JOB DESCRIPTION Job Summary

Provides strategy and leadership to team responsible for compliance activities. Seeks to ensure the organization adheres to regulatory requirements, industry standards, and Molina internal policies, and prevents and/or detects violation of applicable laws and regulations, and protect the business from liability of fraudulent or abusive practices. Plays a crucial role in developing and implementing compliance programs/initiatives, and advising executives on regulatory matters.

Work Location - Wisconsin

Essential Job Duties
• Demonstrates leadership and provides strategic support for the compliance function for area(s) of responsibility; demonstrates accountability for performance and keeps executive leadership apprised.
• Oversees day-to-day compliance operations for areas(s) of responsibility; ensures the compliance program, compliance plan, and code of conduct are adhered to, and mitigates fraud, waste and abuse (FWA) and risk, and ensures compliance with governmental and contractual requirements.
• Leads Compliance in facilitating external Center for Medicaid Services (CMS) or state Medicaid agency audits, including inbound and outbound communications with the auditor, monitoring deadlines, quality control reviews of submissions, and providing compliance expertise to internal business teams in development of responses.
• Serves as a key liaison with state or federal program integrity regulators.
• May oversee follow up and resolution of compliance related investigations
• Provides leadership, training and education related to compliance requirements.
• Enforces the enterprise compliance plan, code of conduct and anti-fraud plan.
• Prepares quarterly written reports to inform the Board of Directors, Compliance Committee, health plan Compliance Officers, or senior leaders on the status of activities pertaining to overall compliance for area(s) of responsibility.
• Provides oversight and assists in on-going facilitation and monitoring of delegation oversight functions.
• Develops, manages, and updates compliance response planning for area(s) of responsibility.

Required Qualifications
• At least 10 years of experience in compliance, risk management, auditing, and/or legal experience, and at least 5 years of compliance program management experience, or equivalent combination of relevant education and experience.
• At least 5 years management/leadership experience.
• Comprehensive knowledge of relevant regulatory health care frameworks and industry standards.
• Strong understanding of governance, risk management, and compliance principles.
• Strong analytical skills, including the ability to interpret regulatory guidance and comply with regulatory agencies.
• Experience developing and implementing compliance programs and controls.
• Strong leadership, strategic thinking, and decision-making capabilities.
• Ability to thrive in a cross-functional highly matrixed environment.
• Strong analytical and problem-solving skills.
• Ability to build rapport and gain the respect and collaboration of internal/external stakeholders.
• Knowledge and ability to think creatively, proactively, and independently.
• Ability to prepare reports and presentations, and manage data.
• Proven ability to set and achieve aggressive program objectives and goals.
• Ability to respond to questions with logic, clarity, calmness and authority which leads to desired support/actions of others.
• Adept at handling complex project planning management issues including the ability to effectively delegate tasks and collaborate cross-functionally.
• Ability to develop, organize, and implement policies and procedures.
• Self-motivated and results oriented.
• Ability to resolve conflict effectively.
• Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Strong organizational skills and the ability to meet delivery targets.
• Demonstrated flexibility in the work environment, willingness, and ability to adapt to changing organizational needs.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency.

Preferred Qualifications
• Previous experience in a health plan or government programs setting (Medicaid, Medicare, Marketplace).
• Experience interacting with health care regulatory agencies.
• Certificate in Healthcare Compliance (CHC), or other compliance-related certification.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package.