Director Compliance-Southwestern Health Resources-Care N Care
Company: Southwestern Health Resources
Location: Arlington
Posted on: January 10, 2021
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Job Description:
Please note:--Southwestern Health Resources Care N Care (SWHR
CNC) is an affiliated company of Texas Health and UT Southwestern.
If hired for this position, you will become a SWHR CIN employee
rather than a Texas Health or UT Southwestern employee.Southwestern
Health Resources Care N Care (SWHR CNC), is hiring for a Director
Compliance.The Compliance Director will serve as a leader and role
model for ethical behavior while dealing with Federal and State
governmental agencies, ensuring compliance with laws, rules,
regulations and policies that govern the Company's business.
Designs and implements programs, policies and practices to ensure
that all departments are in compliance with Centers for Medicaid
and Medicare Services (CMS), Texas Department of Insurance (TDI)
and any other relevant State regulatory departments of insurance,
NCQA, HIPAA, and accreditation standards. Maintains compliance with
federal, state and local regulatory requirements. Tracks laws and
regulations that might affect the organization's policies and
procedures. Prepares compliance reports to present to senior
management, the Company's Audit & Compliance Committee and its
Board of Directors.The Compliance Director will report directly to
the VP Chief Compliance Officer with a dotted line to the Senior
Vice President Strategy/Operations and CEO of CNCSalary range is
Min. $94,536/year to Max. $145,288/year - based on relevant
experience Location: Remote for nowWork Schedule --- Full time, day
shift Job Description MANAGEMENT AND OVERSIGHT COMPLIANCE
PROGRAMS:Oversees compliance with contractual and regulatory
requirements so as to ensure performance levels that meet
contractual, regulatory and organizational
standards/requirements.Interfaces with Operations and
Sales/Marketing to ensure Company meets all government agency
reporting requirements.Maintains working knowledge of Medicare
regulations, the managed care industry, and pertinent
legislation.Provides compliance guidance and oversight to business
leaders in the strategic development of its products.In
coordination with the SWHR-CIN Chief Compliance Officer, develop
and maintain effective communication channels with internal and
external stakeholders.Support the SWHR-CIN Chief Compliance Officer
with conducting compliance committee meetings for the
Company.Develop an annual compliance work plan(s) focused on
continuous improvement of processes in identified risk areas and
other areas as identified by the SWHR-CIN Chief Compliance
Officer.Establish, oversee and conduct compliance investigations,
recommend corrective action and monitor compliance.Analyze data,
implement benchmarking and publish dashboards for key compliance
areas. MONITORING, AUDITING AND ENFORCEMENT:Assesses the Managed
Care (including Medicare, other governmental programs, and
Commercial) lines of business by defining the general course for
the compliance department, identifying and referring issues for
senior staff determination which affect the compliance of the
programs, monitoring legislatives and regulation activity to
determine how it might affect the programs, and develop effective
processes and procedures to support compliance with laws,
regulations and policies.Audits operational areas supporting the
Company's products, including first tier, downstream and related
entities to ensure regulatory compliance and implements, manages
and/or monitors corrective action for identified
deficiencies.Collaborate with business leaders to develop and
review new products in accordance with regulatory requirements and
policies and procedures.Participates in the exclusion screening
process to ensure all covered persons are screened regularly and
investigate any issues that arise through this process. POLICIES,
PROCEDURES, AND STANDARDS:Directs the development and
implementation of compliance programs, policies and procedures
designed to ensure compliance with all applicable federal and state
laws and Medicare Advantage (MA) regulations. The ideal candidate
will possess the following qualifications EducationBachelor's
Degree in healthcare administration, health information management,
public health, health policy, business administration, or related
field is requiredMaster's Degree in healthcare administration,
health information management, public health, health policy,
business administration, health law, or related field
preferredExperience7 years Managed Care compliance or operations to
include 4 years' Medicare Advantage regulatory compliance
requiredSkillsComputer skills: experience with Windows, based
applications and computerized lead management systems.Proven
managerial leadership ability with an understanding of the
operational and regulatory aspects of running a business.Ability to
create a vision and supporting business strategies.High degree of
interpersonal skills, influence, negotiations and problem-solving
abilities and excellent communication skills.Extensive
understanding of goals, procedures, jobs and dynamics of managed
health care.Must be able to frequently problem solve, make
decisions, interpret data, organize and analyze work flow, write,
plan, and use simple arithmetic.Must be able to operate general
office equipment including but not limited to: computer, phones,
and related media and information devices.Must have the ability to
communicate in writing, speaking, and hearing, both in person
and/or by telephone.Additional Information * Organization:
CareNCare InsuranceCompany Inc* Location: Arlington, Texas, United
States* Shift: Day Job* Schedule: Full-time* Pay Basis: Hourly*
Minimum Salary: US Dollar (USD) 45.45* Market Salary: US Dollar
(USD): 55.70* Maximum Salary : US Dollar (USD) 69.85
Keywords: Southwestern Health Resources, Arlington , Director Compliance-Southwestern Health Resources-Care N Care, Executive , Arlington, Texas
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