Insurable Risk Manager (Healthcare)

Location US-CA-Los Angeles
Job ID
2022-15134
Category
Compliance / Risk Management

Overview

The Consultant III provides support for all operations and initiatives critical to enterprise-wide Compliance Program needs. Through effective partnerships with business unit stakeholders, this individual supports insurable risk management and compliance functions.

 

This experienced professional effectively responds to compliance inquiries of high complexity while assessing and mitigating elements of organizational risk. The Compliance Consultant III demonstrates exercise of independent judgment related to situations of a sensitive, confidential nature and is responsible for varied and extensive duties requiring considerable initiative and ability to make decisions relative to efficient program operations.

 

Specific risk management requirements are:

Experienced in the Insurable Risk Management function including:

  • Processing insurable risk claims
  • Engagement and retention of external counsel
  • Processing subpoenas, court orders, attorney requests, etc.
  • Knowledgeable of insurance application and renewals processing

Technical understanding of information systems.

  • Experienced with databases.
  • Experience in development of communications and training plans

Knowledgeable of Enterprise Risk Management processes

Responsibilities

1. Experience in the primary Compliance discipline; Risk Management, Privacy or Vendor Oversight.
2. Independently manages compliance projects of high complexity to the desired outcome.
3. Establishes and executes on program work plan items within compliance specialty area.
4. Develops, implements, and maintains compliance policies and procedures.
5. Serves as compliance auditing, investigation and consulting resource to organization. Provides project management, coordination, and analytical support for compliance projects. Provides consultation on internal and external requirements. Evaluates regulatory requirements and potential operational impacts. Advises operational units on policy, procedure, and operational work plans development.
6. Performs risk assessment and mitigation activities and audits as related to compliance. Conducts initial and periodic assessments, risk analysis, and audits.

7. Develops and monitors corrective action strategies and action plans. Communicates status of same to leadership.
8. Monitors and keeps leadership abreast of regulatory issues, deficiencies, or potential problems that may have financial impacts or involve regulatory intervention activities.
9. Communicates regulatory issues, deficiencies, or potential problems as they relate to possible financial impacts and/or regulatory intervention activities. Develops implements and coordinates training programs.
10. Assists in identification of compliance program needs. Recommends and develops strategies and plans to address same. Develops supporting documentation for compliance program. Reviews and revises Compliance department work plan on regular basis.
11. Assist with investigating allegations of non-compliance or regulatory violations, including those received from the anonymous or confidential hotline. Reports findings and resolutions to leadership.
12. Assist with the implementation of Compliance program communication and training plans, including collaborating with other corporate support teams business units.

13. Provide guidance with interpreting regulations and health plan guidelines.
14. Trains and develops staff and appropriately discerns and escalates issues that require management and communication upward.
15. Other duties as assigned.

Qualifications

1. Minimum of five (5) years of experience working in Compliance, Risk Management or Legal function required. Minimum of five (5) years’ experience in a healthcare discipline preferred.
2. Bachelor’s degree in Healthcare, Hospital, Public, or Business Administration, Human Resources Management or another approved related field; or an equivalent combination of education, training, and work experience required. Master’s degree preferred.
3. Professional certification in Audit, Compliance, Privacy or Risk Management preferred.

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