23 days old

Senior Contract Compliance Manager

Magellan HRSC, Inc.
Baton Rouge, LA
  • Job Code
    R00000021885
Responsible for the oversight of regulatory and contract compliance for all functional areas for markets managed by the Health Plan. Including the oversight of regulatory compliance with the Center for Medicare and Medicaid Services, OIG, and State and federal requirements. Responsible for the implementation of the Compliance and Risk Management plans, HIPAA audits, internal operational compliance audits, and external State and Federal audits. Must be able to function independently, display excellent judgment and approachability, and under the direction of the Local Compliance Officer, collaborate with leadership, as well as clinical staff and providers regarding coordination of care and administration of plan benefits. Ensures that systems and processes are created and maintained as needed to track, trend and manage compliance notifications, issues, corrective action plans, audit results etc. and use those results to support the Local Compliance Officer in the creation and execution of the Compliance and Risk Assessment and Management plans.

Essential Functions:

  • Implements and oversees the ongoing operation of the Compliance Program in the health plan. 
  • Maintains thorough and in-depth knowledge of Federal and State managed care regulatory requirements related to assigned care center.
  • Designs and executes operational monitoring plan of key compliance indicators.
  • Facilitates, organizes and manages government oversight audits, targeted requests for data from regulators, and all site visits. Prepares company personnel for interactions with regulators and auditors.
  • Creates and organizes the partnership process between the Compliance Department and operational/functional areas.
  • Manages the contract and regulatory change process; develop and facilitate training and effective communications for staff and management. 
  • Directs and leads complex compliance projects, applying comprehensive knowledge of best practices, managed care operations, health care policy and government regulations to ensure superior outcomes.
  • Analyzes government regulations, polices and legislation to identify impact on business operations, policies and planning, and as necessary, works with business owners to mitigate impact. 
  • Key contributor to the health plan?s annual risk assessment.
  • Supports the Local Compliance Officer in the development and maintenance of a formal written compliance program for the health plan.
  • Ensures the health plan management team and staff receive appropriate education about compliance and the appropriate details of the compliance program.
  • Directs State and Federally mandated legal and regulatory compliance activities. Serves as a liaison for customers on legal and regulatory issues. 
  • Generates periodic reports documenting compliance effectiveness status. 
  • Ensures corrective actions, as issued by the Local Compliance Officer, are implemented and effective.  
  • Executes compliance oversight process for all delegated vendors, including the health plan?s Pharmacy Benefit Manager.
  • Supports the Local Compliance Officer in preparing and presenting Compliance Effectiveness reports to the Board of Directors and the Compliance Committee for the health plan.
  • Works with business leaders to ensure that a specialized training process is in place and effective.

General Job Information

 

Title

Senior Contract Compliance Manager

Grade

26

Job Family

Legal Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

9/27/2018

Date Requisition Created

9/25/2018

Minimum Qualifications

Education

Bachelors (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Master's degree in a legal or health related profession preferred.
  • Certification in Healthcare Compliance (CHC) preferred.
  • Experience directing Compliance activities in a Managed Care Company strongly preferred.
  • 5-8 years compliance related experience, preferably in health care field
  • Knowledge of HIPAA, federal and state regulatory requirements.
  • Strong interpersonal, organizational, and project management skills.
  • Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
  • Excellent verbal and written communication skills.
  • Previous experience with start-up operations in a new managed care plan.
  • Strong analytical, decision-making and creative solving skills.
  • Previous leadership experience, providing guidance, mentoring and direction to direct reports, and to cross-functional teams, including senior leadership teams.
  • Proven success at developing employees, growing and managing dynamic teams and meaasuring employee and team contributions in achieving compliance initiatives.
  • High level of member-centricity.
  • Experience and thorough understanding of MS Office, including word processing, flow charting, and archiving and other relevant software systems and applications.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled







Posted: 2018-09-27 Expires: 2018-10-26
Sponsored by:
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Sponsored by:
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Senior Contract Compliance Manager

Magellan HRSC, Inc.
Baton Rouge, LA

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