We are representing an established healthcare technology in their search for a Senior Director Compliance and Delegation in the Greater Washington DC area.
Why Join Us:
• Opportunity to lead the operational compliance aspects of a robust, enterprise-wide compliance and ethics program
• Fast-growing organization of over 2,000 employees, partnering with all 25 of the top 25 US Health Plans and all 25 of the top 25 global pharma companies
• Direct interaction with C-Suite executives and other senior management to advance compliance objectives and provide related strategic direction in support of business objectives
Responsibilities:
• Managing a team of six, you will have oversight responsibility for a variety of enterprise-wide compliance functions for a privately-held healthcare technology company, to include the Corporate Compliance Program, Vendor Oversight Program, operational compliance, delegation oversight, auditing and monitoring, and other healthcare industry compliance activities
• This role will also advise and direct on federal and state compliance requirements related to government health care benefits programs, including Medicare, Medicaid and Affordable Care Act/commercial insurance markets
• Oversee and direct the day-to-day operations of the Corporate Compliance Program; conducting internal audits, managing external audits, assessing and mitigating compliance risk, and navigating compliance requirements that impact business, products, operations and systems across the enterprise
• Oversee Vendor Oversight Program and all aspects of regulatory vendor and delegation management for business partners, which includes managing policy reviews, leadership of all vendor oversight functions; ensuring vendors’ contractual compliance; and assuring compliance with Centers for Medicare and Medicaid Services (CMS), state Medicaid and insurance department regulations, National Committee for Quality Assurance (NCQA) standards and other relevant guidance
• Lead compliance activities associated with the company’s subcontracted clinical vendors (e.g. nursing professional corporations, retail clinics, clinical laboratories, transportation companies), and client-delegated credentialing functions
• Serve as the subject matter expert for operational compliance matters for both internal and external stakeholders (e.g., counsel business leaders on compliance approach, regulatory considerations relating to new product development/expansion and other considerations in support of business objectives)
• Oversee the coordination and implementation of client corrective action plans for compliance, regulatory and delegated areas
• Adhere to all confidentiality and HIPAA requirements as outlined within company policies and procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position
Qualifications:
• Essential Education: Bachelor’s Degree
• You will bring several years of senior level healthcare compliance experience, including significant expertise in and practical exposure to managed care, risk and audit and general healthcare regulatory compliance
• You should have a strong knowledge of CMS, Medicaid and other federal and state regulatory and accreditation requirements
• You will bring several years of people management experience, demonstrating the ability to upskill and drive a collaborative and productive team culture
Application Process for Senior Director Compliance & Delegation:
Qualified professionals are to submit resume to Steve Harrison: steve@conselium.com
