We are exclusively representing an innovative healthcare management organization in its search for an Interim Director of Compliance and Contracts.
Why Join Us:
• Make a meaningful impact on patients’ lives by joining a leader in practice transformation and care coordination.
Expectations:
• Maintain Client’s Compliance Program as well as negotiate, manage and maintain a variety of contracts with providers, payors, and strategic partners on behalf of the organization and its clients.
Principal Responsibilities
• Oversee Client’s Compliance Program and its related activities to improve the efficiency and quality of services, reduce vulnerability to fraud, abuse, and waste, and prevent illegal, unethical, or improper conduct.
• Initiate and direct the conduct of internal investigations in response to reports of possible compliance violations. Such investigation will be in collaboration with other departments through appropriate existing channels for investigation and resolution. Consults with external counsel, as needed, to resolve issues as appropriate.
• Ensure proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
• Maintain an effective compliance communication program for the organization, including providing a system for the reporting of violations by personnel through an anonymous hotline and other resources as necessary.
• Respond to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures and corrective actions.
• Provide reports on a regular basis, and as directed or requested, to keep the Executive Leadership Team and Board of Directors informed of the operation and progress of compliance efforts.
• Direct the performance of system-wide audits to investigate and monitor compliance with federal and state standards. Work with the Executive Leadership Team, and others as appropriate, to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.
• Conduct audits related to Medicaid, HIPAA, behavioral health services, and information security guidelines
• Monitor the performance of the Compliance Program and related activities on a continuing basis, taking appropriate steps to improve its effectiveness.
• Perform initial and periodic information privacy risk assessments and conducts related ongoing compliance monitoring activities in coordination with other compliance and operational assessments.
• Provide educational material to the Management team regarding new laws and regulations and perform the necessary research to obtain a working familiarity with new laws and issues affecting health care.
• Conduct compliance risk assessments for the organization to identify potential areas of compliance vulnerability and risk to facilitate development of a compliance work plan.
• Lead complex negotiations and/or contracting arrangements which require developing a sound business strategy for the financial and legal terms required for such contracting initiatives.
• Assure contractual arrangements meet financial budgetary targets and legal and/or regulatory compliance requirements.
Qualifications:
• Bachelor’s Degree required; JD preferred
• Minimum of 7 years’ experience in a healthcare organization, to include demonstrated leadership
• Experience with Medicaid required
• Familiarity with operational, financial, quality assurance, and human resource procedures and regulations
• CHC, CHPC, or other compliance and privacy certification preferred
This is a remote opportunity.
Application Process: Qualified professionals are to submit resume to Jessica Simpson at: jessica@conselium.com
Published by Conselium Executive Search, the global leader in compliance search.
