Corporate compliance director job description

Senior level compliance position that is responsible for the management, execution, and oversight of the compliance program activities and deliverables of a Medicaid managed care organization operating in a highly complex regulatory environment. Oversees the activities of other compliance team members assigned to the market. This position is responsible for developing and maintaining systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in the assigned Medicaid health plan. Responsibilities include, but are not limited to:• Serve as the designated Compliance Officer for Aetna's Illinois Medicaid health plan• Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities • Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners in conjunction with health plan leadership through final report and corrective action plan closure • Lead and execute all elements of the Medicaid compliance program for Aetna's Illinois Medicaid health plan• Conduct research and develop recommendations to help develop compliant business operations, processes and policies in accordance with state specific Medicaid program requirements• Develop compelling, strategic, and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests• Maintain an in-depth working knowledge of the health plan's contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education, training, and business decision making purposes• Ensure that current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools are current and accessible to business partners to ensure the appropriate monitoring and oversight of health plan compliance processes• Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance• Lead and direct oversight and monitoring activities to evaluate levels of compliance with new and existing Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channels• Maintain positive, productive relationships with internal and external senior level constituents to effectively communicate and influence ethical and compliant outcomes • Provide training and guidance to less experienced team members to accomplish goals• Other duties as assigned
Pay Range

The typical pay range for this role is:

Minimum: 100,000

Maximum: 221,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

• 10+ years compliance experience• 7+ years previous experience in Medicaid or Medicaid managed care• 2+ previous management experience• Project Management• Must be located in Illinois• Ability to be on site at the Downers Grove office as needed

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications

• Audit experience• Master's degree in Public Policy, Health Care Administration, Public Administration or similar fields or a law degree

Education

• Bachelor's degree with equivalent work experience• Master's degree preferred

Business Overview

Bring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

About NYC Health + Hospitals

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Director of Corporate Compliance and Privacy, reporting to the Senior Director of Compliance Operations, plays an integral role in the oversight and management of our Corporate Compliance, Vendor Compliance and Privacy Programs. Overseeing a team of compliance analysts, this role is responsible overseeing daily operational and functional requirements of the programs related to this area.

Job Description

• Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives. Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance.
• Oversee the Corporate Compliance and Privacy investigations. Ensuring timely completion. Essential to this role is the ability to track and trend emerging issues and how we may be able to respond on an organizational level.
• Respond to questions and concerns relating to general corporate compliance, privacy and vendor compliance matters, including exclusion screening, fraud, waste and abuse concerns, institutional gift policy, etc.
• Supporting the annual plan risk assessment and collaborating with the Regulatory Compliance team, to assist in identifying areas with potential compliance issues and develop work plan activities.
• Track and trend corrective action plans (CAPs) related to all areas of responsibility. Ensuring CAPs are addressed and closed in a timely manner. Be able to identify systemic issues and work with the Sr. Director to develop solutions.
• Manage ongoing relationship with the Special Investigations Unit internally as well as with our delegated vendors performing FWA activities. This includes: Leading monthly meetings, ensuring ongoing collaboration and developing solutions as issues arise.
• Review and confirm the accuracy of the data we are submitting to external agencies from both Corporate Compliance and Privacy.
• Compile and finalize reports from areas of oversight for internal reporting purposes. Includes: Vendor Delegation Oversight, Compliance Committee, Fraud, Waste and Abuse Committee, and Audit and Compliance Committee. Work with the Senior Director to develop agenda and highlight issues that must be brought to the attention of the Committees.
• Develops and/or ensures that internal controls are implemented to prevent and detect instances or patterns of illegal, unethical, or improper conduct.
• Serving as participating member of the Vendor Delegation Oversight Committee, the Fraud, Waste and Abuse Committee and the Compliance Committee representing Corporate Compliance, Privacy, and FWA concerns.
• Leads response efforts for regulatory filings, audits, and other oversight activities by regulators.
• Monitor key elements of the Corporate Compliance, Vendor Compliance, and Privacy Programs and ensure supporting policies and procedures are reviewed and updated on an annual basis and as needed.
• Keeping up to date on the latest developments and federal and state laws and regulations.
• Assisting with development and implementation of training programs for members of the workforce addressing compliance, privacy, and FWA related topics.
• Provides direct management of the Senior Corporate Compliance Analyst, Privacy Analyst, and Senior Vendor Compliance Specialist.
• Other activities as assigned by the Senior Director or Chief Compliance and Regulatory Officer.

Minimum Qualifications

• Bachelor's degree in a health-related field.
• Minimum of 7 years of experience in healthcare compliance.
• Preferred candidate will possess:
  • Master's degree in business/public administration or public health.
  • Health insurance plan and/or health care industry work experience.
  • Knowledge of Medicaid, Medicare, Affordable Care Act, and HIPAA.
  • Knowledge and experience in information privacy laws; access and release of information; FWA standards; and principles of change management.
  • Excellent analytical, organization, and oral and written communication skills.
  • Expertise with Microsoft Office Suite.

Licensure and/or Certification Required

• CHC, CHPC, and/or CCEP

Professional Competencies

• Integrity and Trust
• Customer Focus
• Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles. The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
• Experience with managed care, Medicare and federal and/or state regulations, quality improvement and compliance oversight.
• High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
• Simultaneously manage multiple projects.
• Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary
• Demonstrated knowledge of managing and building relationships with stakeholders, including senior management, with strong influencing and negotiation skills.
• Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team.
• Sound working knowledge of Windows-based software packages, including Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools.