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The Director, Compliance ensures compliance with governmental requirements. The Director, Compliance requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

The Director, Compliance ensures compliance with governmental requirements. The Director, Compliance requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

The Director of Compliance (Contract Administrator) will report directly to the State Market Leader for Medicaid (Ohio CEO) and board of directors on all compliance issues and will manage the connection of MCO personnel to the Ohio Department of Medicaid business owners. They will also develop and implement written policies, procedures, and standards to ensure compliance with requirements set forth in the Contract.

This individual identifies and analyzes potential sources of loss to minimize risk.

• Serves as the primary point of contact for all MCO compliance issues
• Coordinating the tracking and submission of all contract deliverables; including fielding and coordinating responses to ODM inquiries
• Coordinating, preparing for, and facilitating random and periodic audits and site visits.
• Assesses and communicates information regarding business risks with functions across the organization representation in Internal Compliance committees and managing LRRs
• Coordinates the preparation and execution of Contract documents, audits, and ad‐hoc visits
• Advises executives to develop functional strategies on matters of significance
• Uses independent judgment requiring analysis of variable factors and determines the best course of action
• Participate in required Compliance meetings with the Ohio Department of Medicaid
• Monitors all functional areas for compliance with the Medicaid contract and follow up for corrections of deficiencies
• Directs implementation of plan projects, state contract initiatives, executive-sponsored initiatives and risk assessments
• Leads compliance monitoring to identify process gaps, validate compliance levels, map processes, oversee implementation of corrective actions, prepare reports/presentations
• Develops strategic plans, makes recommendations to leadership, assesses and communicates information regarding business risks with functions across the organization
• Oversees development, execution and compliance with Business Continuity Plan and associated state reporting
• Develops strong relationships with external state partners and internal leaders to identify and address compliance risks and failures
• Ensures the preparation and execution of state ad hoc requests aligns to requirements
• Ensure program compliance with federal, state, and contractual requirements; collaborate with appropriate business areas to develop policies, procedures, and systems to secure and demonstrate compliance with all mandates
• Research potential compliance issues and recommend changes that assure compliance with contract obligations
• Develop and implement compliance policies and procedures
• Ensure the tracking and timely submission of all Contract deliverables
• Maintain relationships with ODM and other relevant government agency contacts
• Participate in Ohio program integrity and Medicaid compliance forums and programs
• Oversee resolution of ODM Contract compliance issues, including corrective action plans
• Field and coordinate responses to ODM inquiries
• Monitor and understand emerging Medicaid policy; provide recommendations and direction in the implementation of new initiatives to be compliant with emerging policy

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree
• Must reside in Ohio
• 8 or more years of experience in operations or compliance‐related field
• 5 or more years of management experience
• Experience working with regulatory agencies, including sate departments of health insurance or CMS
• Extensive knowledge and experience working with state administrative codes and regulations, Medicaid, managed care, and insurance laws and regulations
• Experience with Microsoft Office Applications: Word, PowerPoint & Excel
• Knowledgeable in process improvement and metrics development and in regulations governing healthcare industries
• Strong communication skills
• Travel 10%

Preferred Qualifications

• Masters/JD preferred
• 5 or more years experience

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology