To oversee the planning, development and operation of clinical compliance including oversight of corrective action planning and health plan oversight in accordance with State and Federal regulations and standards set forth by URAC, NCQA, CMS and Utilization Management standards and processes. These activities are supervised and supported by the VP of Compliance, Auditing and Medicare Progams, the SVP, Clinical Operations/Compliance, Chief Medical Officer or Associate Chief Medical Officer.
Minimum Experience Required
Five or more years of experience in healthcare, preferably health plan (or delegated vendor or physician office management) experience. Three or more years of management experience. Two or more years of experience in researching compliance matters and drafting policies and committee minutes. Ability to independently evaluate and analyze regulatory information in order to plan, develop and monitor clinical work processes. Ability to work effectively with varied levels of personnel, with professional and business organizations.
Clinical and/or managed care experience
Strong communication and analytical skills
Knowledge of industry regulatory requirements
Knowledge of principles and procedures of utlilization management
Ability to communicate effectively and professionally, both verbal and written
Ability to handle confidential information
Ability to perform effectively in a fast-paced environment
Ability to multi-task and work independently in a variety of professional settings
Excellent organizational and time management skills
Professional aptitude to solve problems, answer questions and apply information based on current circumstances
Ability to lead inter and intradisciplinary committee meetings and record activities of same.
Fluent in Microsoft office products.
Career ID 2018-4550