Associate Vice President, Compliance Implementation(Managed Care Experience Required)

Job Summary:

The Senior Director, Compliance - Growth and Implementation is responsible for supporting the organizations new market growth and provide compliance oversight and guidance related to significant regulatory implementations.

Essential Functions:

• Assist with new market Medicaid expansions including regulatory guidance, policy and procedure drafting, readiness review and other implementation requirements
• Assist with existing market Medicaid new contract implementations including regulatory guidance, policy and procedure drafting, readiness review and other implementation requirements
• Provide compliance assistance to the operational and implementation teams to oversee effective readiness for the expansion of Medicare and Marketplace lines of business  
• Collaborate with the compliance team members to keep compliance team members informed of status of implementation and readiness activities
• Draft at least quarterly status reports for the Corporate Compliance Officer/Committee and Enterprise Executive Leadership regarding implementation efforts and product expansion efforts
• Direct periodic department or line of business compliance reviews to assess implementation efforts with regulatory requirements including company policies, state and federal laws and regulations
• Direct and/or assist in the development of KCIs and other key metrics related to key Medicaid contractual requirement and Medicare and Marketplace requirements in new markets
• Identify areas of risk requiring the establishment or enhancement of internal controls, policies and procedures, products and/or services, and training associated with any compliance obligations
• Maintain positive and strategic relationships with internal and external stakeholders
• Provide management and oversight of professional staff
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in business or related field or equivalent years of relevant work experience is required
• MBA or JD strongly preferred
• Minimum of seven (7) years of healthcare operations or clinical experience or providing counsel to same, including three (3) years in Government Program products is required
• Minimum of five (5) years of Compliance Program leadership experience or five (5) years health plan quality program experience is required with focus on compliance audit/monitoring activities is required
• Minimum of three (3) years previous management experience is required, compliance oversight leadership experience within healthcare operations is preferred
• Significant regulatory implementation experience is required
• Support new market expansions is preferred

Competencies, Knowledge and Skills:

• Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid/Marketplace and Medicare)
• Exceptional project management skills
• Strategic management and leadership skills
• Ability to work independently and within a matrixed environment
• Attention to detail and strong communication skills necessary
• Demonstrated critical listening and thinking skills
• Negotiation skills
• Time management skills including creation and maintenance of project timelines
• Decision making/problem solving skills
• Advanced level experience in Microsoft Word, Excel and PowerPoint

Licensure and Certification:

• Certified in Healthcare Compliance (CHC) preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$132,900.00 - $232,700.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

This job description is not all inclusive. CareSource reserv