Vice President, Compliance
Company: Inland Empire Health Plans
Location: Rancho Cucamonga
Posted on: March 19, 2023
|
|
|
Job Description:
A reasonable salary expectation is between $240,676.80 and
$330,928.00, based upon experience and internal equity.Position
Summary/PositionUnder the direction of the CEO and Board of
Directors, the Vice President, Chief Compliance Officer (VP
Compliance) will collaborate with the Executive Team, senior
leadership team, and external consultants as needed to implement
and facilitate the organization's Compliance Program.The VP
Compliance is a key leadership role that acts as the Chief
Compliance Officer and is responsible for providing strategic and
operational leadership pertaining to compliance and regulatory
issues as well as oversight of the enterprise-wide comprehensive
compliance program that includes both Medi-Cal and Medicare
Compliance Programs that meet and exceed the OIG's compliance
guidance components and elements of an effective program. The VP
Compliance also oversees the development of a compliance risk
management program to assess, prioritize, and manage regulatory and
legal compliance risks based on state and federal guidelines and
requirements through the systematic assessment and management of
compliance risks.The VP Compliance is also responsible for
enterprise-wide confidential reporting systems allowing employees,
customers, contractors, and other stakeholders to disclose
violations of the corporation's ethical standards, violations of
law, or corporate policy relating to such matters without fear of
retaliationThe VP Compliance will ensure alignment with the
mission, core values, policies, and strategies of IEHP. The VP
Compliance will ensure accountability and compliance with
applicable legal, governmental, and regulatory requirements.Major
Functions (Duties and Responsibilities)The Vice President, Chief
Compliance Officer acts as the Chief Compliance Officer for IEHP
and is responsible for the overall strategic direction and
implementation of the Compliance Program. Duties include, but are
not limited to:1. As a member of the leadership team, participate
and contribute to the overall IEHP Mission, Vision and Strategic
priorities, as established by the CEO and Board of Directors.2.
Provide strategic direction and advise on IEHP's compliance program
design, implementation and monitoring.3. Provide executive
strategic leadership to Compliance operations including the
development and distribution of written standards of conduct,
policies and procedures that promote the organization's commitment
to compliance.4. Review the content and performance of the
Enterprise-wide Compliance Program, including compliance policies
and procedures and code of conduct on a routine basis and takes
appropriate steps to ensure its effectiveness to prevent, detect,
and correct illegal, unethical, or improper conduct with the
organization.5. Develop, implement, and present regular compliance
and risk management training and education to executive staff and
the Board of Directors at least annually and as needed. Such
training includes introductory compliance training, as well as
ongoing training on compliance related topics as needed.6. Provide
executive oversight and maintenance of the compliance hotline and
processes to receive and resolve complaints and concerns;
development and management of policies and processes to respond to
allegation of improper or illegal activities; auditing and
monitoring to ensure compliance with applicable regulations,
policies and OIG elements of an effective compliance program.7.
Provide executive oversight of IEHP's Fraud, Waste and Abuse (FWA)
and Special Investigations Unit (SIU) programs.8. Establish
development and strategic oversight of processes to ensure
non-employment/engagement of individuals or entities excluded from
participation in State and Federal health care programs (sanction
and exclusionary check).9. Ensure appropriate enterprise-wide
policy development, staff education, investigations of alleged
regulatory and policy violations, compliance monitoring, and
auditing.10. Serve as the Chair for the Compliance Committee and
serves in an advisory capacity to keep executive leadership and
senior management informed on the operation and progress of the
organization's compliance efforts.11. Oversee the development,
implementation, and maintenance of an effective compliance
communication by partnering with various departments such as Legal,
Human Resources, Operations and other departments as required.12.
Provide real-time guidance to business unit leadership related to
the timely and effective dissemination and interpretation of
regulatory requirements and changes. Work with the Operations
leaders to ensure timely and effective operational implementation
and oversight of new regulatory requirements and changes.13. Work
collaboratively with operational leaders, medical directors, staff,
network providers and first tier, downstream and related entities
(FDRs) in leading external regulatory audits.14. Budget, recruit,
manage, develop, and retain the necessary resources to successfully
perform the Compliance function.Supervisory Responsibilities
Leader: Administers Hires, Terminations, and Performance
ReviewsExperience QualificationsTotal experience should include a
required minimum of ten (10) years of compliance experience in
managed care with at least five (5) years of senior management
experience.Education QualificationsMaster's Degree, such as but not
limited to MPH, MPA, or MHA from an accredited institution
required.Professional CertificationCertified in Healthcare
Compliance (CHC) on hire or within six (6) months of hire
date.Drivers License Required Yes, must have a valid California
Driver's License.Knowledge RequirementSubject matter expertise
level knowledge of federal and state health care compliance laws
and regulations, OIG enforcement methods, and other applicable
federal and state compliance guidance, as well as industry best
practices in compliance. Ability to understand, interpret, and
apply complex state and federal health care compliance laws, rules,
regulations and guidelines; perform research analysis of health
care laws, regulations, and policies. Extensive knowledge of
Medi-Cal and Medicare rules and regulations, and managed care in
California. Demonstrated understanding and sensitivity to diverse
and multi-cultural environment and community.Skills
RequirementExcellent writing, interpersonal communication and
organizational skills in a variety of situations. Proficient with
Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) to
effectively track and manage deliverables. Demonstrated ability to
develop and deliver comprehensive compliance training and education
to all levels of staff, including members of the Board of
Directors.Abilities RequirementAbility to understand, interpret and
apply complex state and federal healthcare compliance laws, rules,
regulations and guidelines; perform research and analysis of
healthcare laws, regulations and policies. Develops high levels of
credibility and accountability. Leads by influence with
transparency and develops direct reports. Ability to establish and
maintain collaborative, credible, trusting partnerships with
individuals across a broad range of people and groups, both
internal and external. Works well under pressure, producing high
quality results.Commitment to Team CultureThe IEHP Team environment
requires a Team Member to participate in the IEHP Team Culture. A
Team Member demonstrates support of the Culture by developing
professional and effective working relationships that include
elements of respect and cooperation with Team Members, Members and
associates outside of our organization.Working ConditionsGeneral
office environment; word processing and data entry involving
computer keyboard, mouse, and screens; automobile travel within
California.The incumbent approved to be hybrid may periodically be
required to report to IEHP's main campus for mandatory in-person
meetings or for other business needs determined by IEHP
leadership.Work Model Location HybridPhysical
RequirementsKeyboarding: Traditional - FREQUENTLY Keyboarding:
Touch-Screen - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Other - FREQUENTLY Use of computer mouse - FREQUENTLY
Hearing: One-on-One - FREQUENTLY Hearing: In a group - FREQUENTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY Hearing:
Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY Communicate:
Verbally engage with customer base - FREQUENTLY Communicate: Give
instructions, advise, warn, instruct - FREQUENTLY Near Visual
Acuity - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY
Lighting - CONSTANTLY Regular contacts: co-workers, supervisor -
FREQUENTLY Regular contacts: recurring clients - FREQUENTLY Perform
complex and varied tasks - CONSTANTLY Develop and maintain positive
work relationships - CONSTANTLY Decision-making - CONSTANTLY
Lead/Influence Others - CONSTANTLY Work review - FREQUENTLY Rapid
Pace of work - FREQUENTLY Control of work pace - FREQUENTLY Pace of
work with faster/slower work periods - FREQUENTLY Problem Solving -
CONSTANTLY Memory - CONSTANTLY Understand and follow direction -
CONSTANTLY Regular and reliable attendance - CONSTANTLYInland
Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal
and Medicare health plan in the Inland Empire. We are also one of
the largest employers in the region, designated as "Great Place to
Work." With a provider network of more than 5,000 and a team of
more than 3,000 employees, IEHP provides quality, accessible
healthcare services to more than 1.5 million members. And our
Mission, Vision, and Values help guide us in the development of
innovative programs and the creation of an award-winning workplace.
As the healthcare landscape is transformed, we're ready to make a
difference today and in the years to come. Join our Team and make a
difference with us! IEHP offers a competitive salary and stellar
benefit package with a value estimated at 35% of the annual salary,
including medical, dental, vision, team bonus, and state pension
plan.Job Type: Full-timePay: $240,676.80 - $330,928.00 per
yearBenefits:
Keywords: Inland Empire Health Plans, Rancho Cucamonga , Vice President, Compliance, Accounting, Auditing , Rancho Cucamonga, California
|
Click
here to apply!
|
