Scope and responsibilities:
Under limited supervision, the Director of Compliance is responsible for developing and overseeing the implementation of strategic and operational objectives and plans according to best practices, internal and external requirements, with a focus on DHCS and DMHC, and in support of organizational strategy. Work is highly varied and complex, and requires a moderate degree of discretion and independent judgement.
- Identifies, develops, plans and executes strategies, participating with peers and others to ensure effective integration; oversees the development and implementation of department goals and actions plans.
- Monitors and tracks organization-wide compliance, including program metrics, structure and processes; identifies and communicates risks; develops actions plans to address.
- Serves as the subject matter expert for management and staff on the conditions and terms of DHCS and DMHC contracts, and other external laws and regulations; collaborates to ensure compliance and alignment.
- Performs validation reviews and risk assessments to evaluate compliance contract requirements and business processes; ensures appropriate documentation in compliance systems.
- Conducts or oversees investigations relative to FWA, HIPAA violations, enrollment activities and other compliance issues or violations as required; oversees the implementation and completion of corrective action plans and other activities.
- Manages the internal and external audit program, including risk assessment, preparation and facilitation; monitors results, escalation issues, notices of non-compliance, warning letters, corrective action plans, fines, penalties, and/or sanctions.
- Establishes and leads the Compliance Committee; ensures meeting minutes are completed and archived.
- Assists in the development of, and oversees implementation of policies, procedures and practices designed to ensure compliance with the requirements set forth by DHCS and DMHC contracts, laws, regulations and health care program requirements.
- Develops and manages department budget.
- Oversees the development, implementation and maintenance of the appropriate and required data, records, reports and other documentation.
- Promotes and maintains, and ensures that direct reports promote and maintain an environment that supports the organization's strategy, vision, mission and values.
- Hires, develops, supervises and retains, and ensures direct reports hire, develop, supervise and maintain, an adequate and competent staff.
- Other duties as required.
- Bachelor's Degree in a related field.
- At least 10 years in compliance including two years in a management role in a health plan or managed care setting.
- At least six years supervisory experience; or equivalent combination of education and experience.
- CHC certification.
- Master's Degree in business, healthcare or public health.
- Experience in compliance, regulatory affairs or state government.
- Expert knowledge of and ability to apply and facilitate the adoption of compliance best practices.
- Ability to create, execute and monitor relevant strategic and business plans.
- Expert knowledge of community, state and federal laws and resources as they related to managed care operations.
- In-depth knowledge of managed care principles and practices as they relate to compliance.
- In-depth knowledge of the business, economic, demographic and political trends and developments affecting healthcare and managed care in general.
- Advanced problem solving and analytical skills, with ability to interpret and determine the impact of complex laws, regulations and other documents, analyze and resolve complex problems of broad scope, develop effective action plans and implement to successful conclusion.
- Ability to exercise keen judgement in difficult situations, balancing the competing interests of executive team and business areas in an effective and professional manner.
- Advanced leadership skills, including but not limited to the ability to support corporate objectives, establish direction, build alliances, and inspire and motivate others across the organization and externally.
- Demonstrated ability to articulate and support the organization's vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
- Strong management skills, including but not limited to the ability to supervise staff in a manner that maximizes employee performance and business results.
- Strong collaboration skills, including but not limited to the ability to create and foster a collaborative work environment, and organize people and resources to solve problems and identify opportunities.
- Strong interpersonal skills, including the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of the organization.
- Strong oral and written communication skills, including the ability to communicate professionally and persuasively to diverse individuals and groups inside and outside of the organization.
- Advanced presentation skills, including but not limited to the ability to tailor presentations to a specific audience, be persuasive and identify key messages.
- Strong skills in budget development and management.
- Strong project management skills, including the ability to manage organizational-wide projects to successful conclusion.
- In-depth knowledge of change management theory, with ability to anticipate and implement effectively.
- Intermediate skills in Word, Outlook, Power Point, Visio and Excel.
- Ability to speak and be understood in English.
- Ability to handle confidential information with appropriate discretion.
- Frequent sitting, standing and walking, constant repetitive motion, constant talking and listening, occasional handling of materials up to 10 lbs., close up and distance vision requirements, occasional travel.
- Ability to cope with a fast paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, occasional public contact, and sensitive situations.
- Bachelor's degree in related field required.
- Master's degree in business, healthcare, or public healthpreferred.