Director, Health Plan Operational Compliance
Blue Cross NCAbout the role
Job Description
Provide leadership, vision, and direction for the defined units within their business area, to include Medicare, Commercial, and FEP Compliance. Lead and set goals for teams responsible for identifying, coordinating, and implementing strategies, frameworks, initiatives/projects and activities that create efficiencies, optimize systems & processes, and promote compliant outcomes. Lead multiple teams united to ensure the integrity within the Health Plan that reflects clear alignment to our enterprise compliance program, as well as regulatory and contractual requirements and policies.Our team creates impact through engagement with business areas to achieve compliant outcomes, including consultative services, project planning, and project leadership, mitigation plan development, compliance audit support and readiness activities, material assurance and agent behavior assurance.
What You'll Do
Lead the development of the strategy, planning and execution necessary to effectively implement legislation and facilitate implementation of strategies and processes that ensure compliance and achieve operational effectiveness and efficiencies.
Direct the maintenance and evaluation of an operational compliance program that is highly effective, meets federal sentencing guidelines and other regulatory requirements, and is deployed to all areas of the Health Plan. The ongoing status of the program is reported to management and the governing body through a committee structure.
Develop and deploy communication and training initiatives that support operational compliance goals and obligations.
Establish standards and procedures for reporting and documentation, monitoring results against specifications, investigation and mitigation of compliance issues.
In partnership with the Enterprise Compliance Office, collaborate with other BCBSNC staff throughout the Health Plan to direct compliance issues to appropriate channels for investigation and resolution.
Lead, manage and set goals for teams responsible for identifying, coordinating, and implementing initiatives/projects and activities that create efficiencies, optimize systems & processes, and promote compliant outcomes
Provide leadership, vision, and direction for assigned teams:
Accountable for all decisions within the group.
Determine team priorities to reflect the organization’s core values and deliverables.
Develop, coach and motivate others to take actions that support and reflect the core values and desired future state.
Develop and manage departmental budgets including forecasting and variance analyses.
Lead initiatives to develop, modify, and improve the effectiveness of the department by looking at processes, root cause analysis, system enhancements, re-engineering, etc.
Direct staff of subject matter experts and analysts on supporting business initiatives, production problem resolution, system enhancements, and configurations to ensure compliant outcomes
Lead and oversee management and delivery of enterprise and departmental projects including business case development, ROI a
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