PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN:

12 Years of business and/or healthcare compliance experience, including working with senior leaders responsible positions within a health system, healthcare law, or healthcare consulting environment.

12 Years of experience in a healthcare leadership role with an emphasis on the implementation of an ethics and compliance program as typically obtained with a minimum of seven years of experience.

12 Years of experience conducting effective and regular training, investigations, risk assessments, auditing, and monitoring activities.

SKILLS AND KNOWLEDGE

Expertise in managing an effective ethics and compliance program, including: infrastructure development; policy management; training; monitoring/auditing; conducting and documenting investigations; addressing and resolving violations, errors, and deficiencies; tracking corrective actions, performing risk assessments, and designing strategies to prevent future compliance problems.

Detailed understanding of healthcare compliance standards, compliance program development and assessment, relevant healthcare operational issues, business ethics and compliance risks and the knowledge to effectively manage those risks in a dynamic healthcare environment.

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, Affordable Care Act and Health Insurance Portability and Accountability Act (HIPAA) regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Insurance Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws, and licensure requirements, and quality standards.

In-depth knowledge of federal and state regulatory filing and reporting systems: national Association of Insurance Commissioners (NAIC) System for Electronic Rate and Form Filing; California Department of Managed Healthcare (DMHC) eFiling web portal; Centers for Medicare and Medicaid Services (CMS) Enterprise Portal; Health Insurance Oversight System (HIOS) Portal; Rates and Benefits Information Systems (RBIS).

Well versed in current and emerging business ethics and compliance topics, project management methodologies and tools, resource management and change management techniques.

Working knowledge of other disciplines outside own area of expertise, including business planning, clinical disciplines, human resources, finance, clinical and financial auditing, and information technology.

Strong organizational skills with an excellent understanding of team building and organizational dynamics, including creative problem identification and resolution, conceptualization, and contingency thinking skills.

Advanced project management skills, including the ability to facilitate and manage multiple complex projects simultaneously while efficiently and effectively achieving objectives.

Superior attention to detail, superior analytical and strategic planning skills with the ability to identify potential issues/risks/trend, analyze data, provide insights to staff and affiliates, and recommend actions to resolve or minimize the impact.

Excellent verbal and written communication, interpersonal, and presentation skills with the ability to explain complex legal and regulatory requirements directives, ideas, and concepts clearly and professionally to diverse audiences and all levels of internal/external leadership.

Competency in Microsoft Office suite (Word, Excel, PowerPoint), including a working knowledge of data management to interpret information and track results, and internet-based legal and regulatory research.

Ability to

• translate complex legal and regulatory requirements into lay terms and provide cogent advice to senior management regarding the impact of compliance enforcement, legislation and regulations on affiliate business strategies, and its not-for-profit mission.
• convert a vision into a strategic and actionable plan with clear ethics and compliance goals and objectives.
• adapt to changing or challenging initiatives while developing new ideas and approaches aimed at improving results.
• foster a collaborative environment, to influence individuals or groups with diverse opinions and to enlist cooperation without direct control/authority.
• maintain strict confidentiality of all compliance and risk management data, and ensure the privacy of each patient’s protected health information (PHI).
• build and maintain collaborative relationships with peers, other departments, stakeholders, consultants, government agencies, and external organizations to achieve regulatory and accreditation compliance.

Pay Range: $78.03-$124.84