At Amergis Healthcare Staffing we are passionate about connecting people to work that matters.Our client in Fresno, CA is looking for strong candidates with a background in managed care plan policies and is well versed with Knox-Keene Regulations to fill their Senior Director of Compliance role.POSITION DESCRIPTIONPOSITION TITLE: Senior Director of ComplianceDEPARTMENT: ComplianceREPORTS TO: Chief Compliance OfficerPOSITION SUMMARY: This position is responsible for directing and overseeing the implementation of our client’s Compliance Program policies and procedures to ensure organizational compliance with state and federal rules and regulations affecting managed care health plans.Under the direction of the CCO, the Senior Director will work collaboratively with staff and its contracted Plan Administrator (Contractor) to ensure and maintain organizational compliance, including the duties and responsibilities listed below. ESSENTIAL DUTIES & RESPONSIBILITIES:
Direct efforts to implement current policies and respond to new directives/deliverables in order to meet federal and state laws/regulations and contractual obligations.
Provide leadership in the development and implementation of compliance-related or compliance- impacting processes and initiatives, and in the timely resolution of issues impacting members’ rights and access to care.
Serve as the secondary liaison to the CCO in responding to DHCS/DMHC compliance matters.
Oversee activities within the Compliance Department’s purview related to Member’s Rights/Services and Provider Network Integrity/Capacity, including associated regulatory data reports, member/provider communications, and Contractor oversight audits.
Direct preparation and response to DHCS/DMHC Medical Audits and associated corrective action plans (CAPs).
Direct and mentor Compliance Department staff.
Prepare and submit DHCS/DMHC regulatory filings and responses to “Additional Information Requests” and “Comment Letters”.
Prepare Compliance reports and presentations for the RHA Commission, Compliance Committee, and Public Policy Committee.
Participate in Work Groups to identify trends/issues of noncompliance and the need for corrective action.
Manage the coordination and preparation of the Plan’s response to any state or federal regulatory agency’s request, review/investigation or audit (e.g. California Department of Justice (DOJ), Office of Inspector General (OIG), U.S. Department of Health and Human Services, Office of Civil Rights (OCR) related to potential fraud, waste and abuse or potential privacy breach.
Proactively acquire and apply knowledge of current federal and state laws/regulations.
MINIMUM QUALIFICATIONS/EDUCATION:
Bachelor’s Degree in Health Care Administration, Public Health Administration, Business Administration, or a related field; Master’s degree preferred.
Certification in Health Care Compliance is required.
Seven to ten years’ progressive experience in Medi-Cal Managed Care compliance is required.
Senior Managerial experience in staff development and evaluation is required.
Strong knowledge of federal and state regulations/requirements.
Knowledge of managed care operations, preferably for government programs.
Ability to effectively develop, analyze, interpret, apply and communicate policies, procedures and regulations.
Good computer skills, must be proficient in Microsoft Office: Word, Excel, PowerPoint, Outlook
OTHER DETAILS
Schedule: Mon-Fri, 8am-5pm
Position Type: Direct Placement
Interview Process: 2-3 Interviews
If you're interested in learning more about this position, submit your resume and we will reach out to schedule a phone interview. Benefits At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
Competitive pay & weekly paychecks
Health, dental, vision, and life insurance
401(k) savings plan
Awards and recognition programs
Benefit eligibility is dependent on employment status.
About Amergis
Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions. Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.