Senior Risk Partner Management

Company :

Highmark Health

Job Description : 

JOB SUMMARY

This job is responsible for planning, designing, implementing, and maintaining the Compliance Program and its related policies to ensure the business acts within the parameters of federal and state laws, regulations, and regulatory guidance.  The incumbent is also responsible for the administration, interpretation, and enforcement of the Compliance Program including auditing/monitoring operational processes, conducting or overseeing compliance investigations, and ensuring that adequate training takes place under the Compliance Program. In this capacity, the incumbent is responsible for the collaborative and iterative development of the risk and compliance plan for these entities across all areas in the enterprise risk taxonomy.  Through matrixed leadership with Risk Operations and with support from Risk Enablement, the incumbent monitors and tracks the delivery of risk activities including, but not limited to, internal and external audit progress, recurring risk and compliance reporting, mandated training, investigations, and the impacts of new and changing laws, regulations, and contractual relationships.  The incumbent must have extensive knowledge of the applicable federal and state rules as well as a solid working knowledge of managed care operations, compliance program structures, information security and audit methodologies. The incumbent must also have a foundational understanding of privacy regulations, including in-depth knowledge of HIPAA and possess the ability to perform a privacy risk assessment. Must have the highest level of integrity and ethics and demonstrate professional representation of the company. 

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Matrixed working relationship with Risk Operations and Strategic Risk Partner to define the development, implementation and maintenance of an effective compliance and risk management program for the supported entities. This includes, but is not limited to education and training requirements, reporting and intake protocols, monitoring and implementation of new or changing regulatory requirements, risk assessment and audit execution, risk treatment plans, policy and procedure maintenance, response and investigation procedures and compliance expectations.
• Acts as a thought partner and advisor to business leaders to ensure business decisions are managed according to the enterprise risk strategy / framework.  Participates in and understands the business operations and strategy.  Serves as a single point of contact for the business’ risks, compliance, privacy and security needs, and partners closely with legal counsel on all efforts. 
• Provide proactive guidance, education, and information to senior management, so that leaders remain informed and aware of risks, requirements, mitigation strategies, and management’s responsibilities.  Leads and participates in discussions or presentations to existing Compliance or Risk Committees and the Audit & Compliance Committee meetings of the Board. Gathers data and prepares reports for senior management and Board of Directors as needed. Ensure reporting obligations are met.  Participates on various risk committees and may represent their entity when appropriate. 
• Informs business of risk related activity for that BU, ensures awareness and monitors execution.  Tracks, monitors and reports on risk operations for the assigned Business Unit (BU) using the standard metrics and reporting created by risk enablement. 
• Through understanding of the business strategy, proactively identifies and addresses risk in partnership with the risk operations and legal functions, and the business leaders.  Serves as a single point of contact to respond and intake risk from the senior leadership team, and follows protocol to triage. 
• Participate in the development and implementation of the enterprise’s risk strategy for effective risk and compliance program governance; intended to strategically and proactively mitigate risk, and promptly detect and correct instances of non-compliance. This includes but is not limited to formal risk assessment processes and the development and implementation of an annual audit plan.
• Liaise with external regulators or enforcement bodies interacting with the a