Compliance & Risk Management Director

Compliance & Risk Management Director

The Director reports directly to the Chief Compliance Officer and serves as a senior leader within the Compliance Department, leading compliance efforts across all functions across One Community Health. The Director manages the following compliance and regulatory functions: management of external regulatory audits, including audit readiness and corrective action plans; enterprise-wide compliance monitoring strategies, administrative and clinical; regulatory agency management, including relationship and complaint management with State and Federal regulatory agencies; regulatory reporting, including design and implementation of quality assurance strategies to ensure reports submitted to regulators are timely, complete, and accurate, The Director develops and recommends strategic compliance initiatives for One Community Health, accountable to continuously streamline and improve the overall effectiveness of the department.

ESSENTIAL FUNCTIONS

• Prioritizes and manages day-to-day operations of the Compliance Department. The Director ensures compliance with laws, rules, and regulations; designs, implements, documents, and maintains an enterprise-wide compliance monitoring program and other specialized tools that clearly outline regulatory requirements; detects and corrects non-compliance on an ongoing basis, and drives ongoing remediation; and standardizes, centralizes, and oversees all compliance monitoring activities.
• Oversees the management of all Policy and Procedures for One Community Health in terms of administering the Policy platform for updating, renewing, drafting, storing and retention of all necessary Policy and Procedures for One Community Health.
• Communicates the importance of compliance to all levels of One Community Health through various methods as needed and as appropriate. Promotes effective lines of communication to and from the Compliance department. Leads, facilitates or participates in relevant committees as Director determines or as assigned by the Chief Compliance Officer and leadership team.
• Manages all regulatory audits and readiness activities; including mock audits, submission quality assurances, corrective action plan development, approval, and monitoring.
• Manages and maintains relations with regulators. This includes reviewing regulatory inquiry trends, notices of non-compliance response, and self-disclosures of non-compliance issues to the regulators.
• Develops and maintains productive relationships with all levels of management, staff, and external stakeholders. Conduct periodic enterprise training on prevention, detection, and correction of non-compliance including but not limited to compliance program effectiveness, regulatory audits, root cause analysis, corrective action plans, and regulatory submissions.
• Develop policies and procedures for the compliance department and review policies and procedures for updates.
• Monitor the license, permits, certificates and other required regulatory license and permits for the organization.
• Monitor the incident reporting management system to ensure all incidents reported are closed timely. Work with the compliance team to resolve these incidents timely by conducting an Incident meeting weekly.
• Monitor any privacy concerns and review with the Compliance and Privacy Manager and Chief Compliance Officer.
• Monitor all training required for HRSA, FTCA and stakeholders such as: health plans.
• Manages all regulatory reports and internal compliance reports. Designs and implements reporting for quality assurance purposes and engages with the Quality department on data analysis and remedial measures to improve outcomes.
• Designs and implements goals and programs that demonstrate strategic thinking focused on achieving operational excellence within the department and with external business partners.
• Prepares quarterly and annual reports evaluating One Community Health's compliance performance for the Chief Compliance Officer and others as directed.
• Oversees the risk management functions for the Compliance department including notice of claims; assisting in claims management; annual insurance renewal and overseeing the functioning of the contract database and management process.
• Oversees the process for the FTCA requirements for the deeming application working with the Chief Compliance Officer and other departments.

Additional Duties

• Provides health center with support on the HRSA Compliance Manual and Site Visit Protocol.
• Conducts research projects for the health center as necessary.
  • Participates in other health center activities such as NCQA accreditation as a Patient Centered Medical Home, Joint Commission Accreditation, Federal Tort Claims Act
• Other tasks and projects as assigned and appropriate.

MINIMUM REQUIREMENTS

• Comprehensive knowledge and understanding of current regulations that govern healthcare operations, including the California Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, CMIA, CCPA, Affordable Care Act and Health Insurance Portability and Accountability Act (HIPAA) regulations, Stark, AKS, and FWA Laws, in addition to federal and state reimbursement program requirements (e.g., Medicare/Medicaid and Medi-Cal) and privacy and consent laws, licensure requirements and quality standards.
• Extensive experience involving healthcare compliance / HIPAA regulatory analysis and implementation regarding the above areas, typically gained from five (5) years' experience in healthcare privacy and/or compliance, including
  • Investigations
  • Audits
  • Regulatory notifications
  • Analysis and presentation of quarterly compliance data
  • Training
• Bachelor's degree in Healthcare administration or a related field required; may be substituted for additional experience in healthcare compliance
• Eligibility for certification in Health Care Compliance.
• Expertise in the following areas, typically gained from 5+ years in a supervising capacity
  • Developing department objectives and measurements to meet organizational goals
  • Staff selection and development
  • Management of department workload
• Ability to maintain strict confidentiality and meet strict deadlines
• High level of professional integrity and business ethics.
• Ability to identify and assess risk.

PREFERRED BACKGROUND

• Describe all those nice-to-haves which will give some candidates a competitive advantage
• Master's or Doctorate in Public Health, Healthcare Administration, or law
• Health Care Compliance (CHC), Privacy Compliance (CHPC), Research Compliance (CHRC), or Auditing certification preferred.

Reasonable Accommodations:

One Community Health endorses and supports the Americans with Disabilities Act of 1990 (ADA) and the California Fair Employment and Housing Act (FEHA) and is committed to providing reasonable accommodations to qualified individuals with disabilities who are applicants or employees who need accommodations. If you require and accommodation due to a disability to complete this application or you are experiencing difficulty submitting your application, please contact us at ochhumanresources@onecommunityhealth.com

Our Benefits:

For information on the comprehensive benefits we provide, please visit: https://onecommunityhealth.com/careers/benefits/