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Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.
Primary Purpose
The Director of Compliance is responsible for managing and improving the Parkland Community Health Plan (PCHP) Compliance Program to assure compliance with State and Federal regulations for the health plan. Assists the Vice President of Compliance with oversight of compliance and regulatory matters and is primarily responsible for overseeing the organization’s operational areas. Serves as an internal consultant to management and staff regarding compliance with Federal and State laws and regulations, contract provisions, accreditation standards, and internal policies and procedures. The Compliance Director will implement plan-wide initiatives related to the Compliance Program and will be responsible for delegation oversight, auditing and monitoring, and tracking corrective action plans. |
Minimum Specifications
Education
Bachelor’s degree in healthcare administration, business administration or a related field. | ||
A Master’s degree, Juris Doctorate or other advanced degree is strongly preferred. |
Experience
Seven years of progressive experience in a compliance leadership role in a health plan and/or managed care organization. | ||
Three years of experience directly interacting with state and federal regulatory agencies (OIG, HHSC, CMS, TDI). | ||
Three years of management experience. |
Equivalent Education and/or Experience
May have an equivalent combination of education and experience to substitute for both the education and the experience requirements. |
Certification/Registration/Licensure
Must have Federal Emergency Management Administration (FEMA) course certification for IS-700.B: An Introduction to the National Incident Management System (NIMS) or obtain within 30 days of placement in role. | ||
Must have Federal Emergency Management Administration (FEMA) course certification for IS-100.C: Introduction to the Incident Command System (ICS 100) for Healthcare/Hospitals or obtain within 30 days of placement in role. | ||
Must have Federal Emergency Management Administration (FEMA) course certification for IS-200.HCA: Applying ICS to Healthcare Organizations (ICS 200) or obtain within 30 days of placement in role. | ||
Must have, or obtain within 24 months of placement in position, one of the following certifications:
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Required Tests for Placement
Skills or Special Abilities
Excellent verbal and written communication skills that are effective with stakeholders and leaders internal and external to the organization. | ||
Ability to communicate with appropriate tact and diplomacy. | ||
In-depth knowledge of Centers for Medicare & Medicaid Services managed Medicare, Medicaid and TDI rules as well as other applicable laws and regulations. | ||
Strong organizational and planning skills. | ||
Ability to evaluate complex healthcare compliance issues and make appropriate recommendations. | ||
Ability to meet strict and intense internal and governmental reporting requirements and deadlines. | ||
High degree of personal integrity and commitment to best practices and ethical conduct. | ||
Computer literate and proficient with Microsoft Word and Excel. | ||
Sound professional judgment and critical thinking skills. | ||
Must be able to garner the trust of others by providing practical, sound, accurate and timely support. | ||
Highly organized with great attention to detail. | ||
Demonstrated strong interpersonal and prioritization skills. | ||
In-depth knowledge of health plan compliance, operations, standards, policies and procedures. | ||
General knowledge of a broad spectrum of health plan laws and regulations. |
Responsibilities
Supports the ongoing operation and sustainability of the Health Plan from a compliance perspective, which includes conducting analysis, documenting findings and summarizing the complexities in a manner that is easily understood, actionable and supports the Health Plan’s effectiveness. | ||
Designs, implements and improves processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and contract requirements. | ||
Manages approval and submission of timely and accurate contract and regulatory required report deliverables. | ||
Works on fraud, waste and abuse program including working with data analytics to identify patterns of potential fraud, waste and abuse. | ||
Serves as an organizational resource (both externally and internally) relating to health plan regulatory compliance matters. Conducts thorough research and provides prompt, courteous consultative services regarding compliance matters. | ||
Assists in developing and disseminating topic-specific education to Health Plan personnel based on identified risks or changes in law or regulation. | ||
Uses data analytics to develop and track Health Plan performance with regards to compliance standards. Works collaboratively with leadership to validate efficacy of the data to support compliance with legal and regulatory requirements. | ||
Implements an organizational framework for monitoring the federal and state regulatory landscape related to the Health Plan and to identify new developments and changes that impact the organization. Works with leaders to communicate requirements and responsibilities. | ||
Manages submission of consumer and provider communication materials, including participation in their review and timely submission to HHSC and the TDI, where applicable. | ||
Conducts on-going assessment for areas of regulatory compliance risk within the Health Plan, and, in close collaboration with Internal Audit, develops an annual compliance auditing and monitoring plan. | ||
Oversees creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies. | ||
Participates in new business implementations, including the identification and tracking of required contract report deliverables and assist with readiness review assessments. |
Job Accountabilities
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Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.
Vacancy expired!