Director Compliance-Southwestern Health Resources-Care N Care

Company: Southwestern Health Resources
Location: Arlington
Posted on: January 10, 2021

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

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