Healthcare Administration - Compliance Manager

About the position We are currently hiring a REMOTE Compliance Manager! If you are experienced in healthcare compliance and auditing, have a strong attention to detail, and value being part of a team that makes a difference, you may be the right person for the position! Apply today! JOB SPECIFICATIONS Classification: EXEMPT | Status & Schedule: FULL-TIME, MONDAY – FRIDAY, 8AM – 5PM Location: REMOTE, LOCAL TO OREGON STRONGLY PREFERRED Work Location: OR, CA, AZ, TX, FL Salary: $3,076.95 - $3,653.85/bi-weekly Department: COMPLIANCE | Reports to: CHIEF QUALITY & COMPLIANCE OFFICER | Supervision Exercised: OVERSIGHT OF COMPLIANCE STAFF Job Purpose: Compliance Manager The Compliance Officer is responsible for a wide range of tasks to ensure DOCS and SWOIPA are in compliance with any, and all, relevant regulations and standards related to Medicaid Managed Care. The position is responsible for Compliance program implementation, oversight and management.

Responsibilities

• Compliance and Auditing Read, mark, learn, and inwardly digest federal, state, and contractual requirements related to Medicaid Managed Care
• Oversee a distributive compliance program in which each department within the organization shares responsibility for assigned compliance functions
• Provide technical assistance to internal departments, providers, and subcontractors, as requested
• Develop, implement, and oversee annual audit plan for compliance with federal, state, and contractual requirements
• Identify and report areas of risk and vulnerabilities and develop responsive procedures, disciplinary guidelines, and corrective action for external monitoring and reviews
• Develop corrective action plans for findings resulting from contractor reviews
• Assist in the development of corrective action plans for EQR reports that result in findings
• Monitor corrective action plans until findings are fully resolved
• Develop compliance program activities, including in-service training programs for board members, staff members, contractors, and providers, with particular emphases given to: (1) Fraud, Waste, and Abuse; (2) Program Integrity; (3) Certifications and Conflict of Interest; (4) Provider Selection and Exclusion; (5) Enrollee Rights and Protections; and, (6) the Patient Grievance System; (7) Human Resources; (8) HIPAA Privacy & Security; and, (9) Contracts
• Oversee monitoring, auditing, and investigation to review significant findings, or trends, through internal and external processes, for the purposes of identifying and responding to potential risk or areas of non-compliance and engaging in corrective and preventative action
• Review and enforce compliance policies and procedures to address areas of risk and to promote internal regulatory and contractual compliance
• Participate in the review of complaints and reports of alleged non-compliance
• Periodically analyze the resources assigned to compliance functions to ensure that such resources are adequate for maintaining an effective compliance program
• Report on a regular basis to the compliance committee on matters involving the compliance program
• Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies and/or officials, as appropriate or required
• Participate in quality and organizational process improvement activities and teams when requested
• Ensure compliance with company policies and procedures as applicable to area(s) of responsibility
• Handle confidential information and materials appropriately and maintain a secure work area
• Other duties as assigned
• Participate in quality and organizational process improvement activities when requested
• Support and contribute to effective safety, quality, and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities
• Openly, clearly, and respectfully share and receive information, opinions, concerns, and feedback in a supportive manner
• Work collaboratively by mentoring new and existing co-workers, building bridges, and creating rapport with team members across the organization
• Provide excellent customer service to all internal and external customers, which includes team members, members, students, visitors, and vendors, by consistently exceeding the customer’s expectations
• Recognize new developments and remain current in care management and coordination best practice standards and anticipate organizational modifications
• Advance personal knowledge base by pursuing continuing education to enhance professional competence
• Promote individual and organizational integrity by exhibiting ethical behavior to maintain high standards
• Represent organization at meetings and conferences as applicable
• Plan, orient and assign work to personnel that supports goals and objectives contained in the organization’s Strategic Plan and delivers outstanding team-based serv

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