Manager of Compliance

Location: Santa Barbara, CA
Date Posted: 11-01-2018
CareNational
Manager of Compliance – Health Plan
Santa Barbara, CA

Manager of Compliance Job Summary:
  • Oversees the process of tracking and investigating reports of alleged fraud, waste, and/or abuse (FWA) from external and internal sources
  • Ensuring that investigations are processed through to resolution and are reported to the appropriate parties/entities   within required timeframes
  • Managing internal/external audits, and audit findings responses and corrective action plans
  • Oversees the development and administration of FWA training for all staff
  • Ensures that Compliance projects support and achieve program goals
  • Working with the Compliance Committee to ensure staff are educated and trained on the compliance program
  • Researching and responding to staff questions regarding regulatory compliance
  • Development and oversight of an internal audit function
  • Preparation of agenda for the Compliance Committee and any related subcommittees, transcription of committee minutes and maintenance of all associated records
  • Maintains and solicits routine approval of the plan’s Code of Ethics document
  • Maintenance of a system for the maintenance of policies and procedures, to ensure compliance with relevant state and federal requirements, contractual requirements, and/or industry standards
  • Coordination of routine audits
  • Oversight of the submission of operational Plan data to the Department of Health Care Services and the Department of Managed Health Care
  • Ensure that the plan meets ongoing non-routine reporting requirements that are requested
  • Stay abreast of changes in contractual provisions or regulations and communicate those changes to relevant staff within the organization
 Manager of Compliance Background:
  • Clinical or Non-Clinical Professional with a Bachelor’s Degree in Healthcare Administration, Business, Leadership, or related field.
  • Around 4-6 years of compliance experience, preferably in a healthcare environment.
  • Prefer 1 or more years of experience working for a Managed Care Organization (Health Plan, IPA, TPA, MSO, etc).
  • Roughly 3-5 years previous management experience, in roles of increasing responsibility.
  • Broad-based background in healthcare and medical management is essential.
  • Requires knowledge of managed healthcare as applied to government sponsored programs.
  • Basic computer proficiency (MS Office and Healthcare IT Systems) and typing skills are necessary.
  • Understanding of operational reports, financial budgeting processes, and health care payment models.
  • Excellent verbal and written communication skills, as well as exceptional critical thinking skills.
  • Strong oral and written communication skills; ability to interact with internal and external contacts.
  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
 
#ADMIN
 
RON AMODIO
STRATEGIC DIRECTOR
CareNational
ron@carenational.com
480.269.9491 (CALL – TEXT – FAX)
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