• SVP and Chief Compliance Officer

    Location US-CA-Commerce
    Job ID
    2018-6933
    Category
    Compliance / Risk Management
  • Overview

    The Chief Compliance Officer is responsible for the development, implementation, and oversight of all activities related to adherence to the laws, regulations and policies that govern its business. The Chief Compliance Officer is responsible for the identification and organization of information and resources related to Compliance requirements and policies; for the communication and training on the importance of Compliance in general; and for the development of policies, procedures and standards related to the Compliance Programs. Additionally, the Chief Compliance Officer is responsible for identifying and assessing areas of compliance risk and developing and implementing plans to reduce risk and maintain compliance. The Chief Compliance Officer will report to the Chief Executive Officer and will have access to the Board of Governors.

    Responsibilities

    1. Oversee the strategic review, planning, implementation, and operation of an effective Compliance and Privacy program with direct access and accountability to the senior management team. Perform regular reviews of the compliance program and recommend appropriate revisions and modifications. Advise senior leadership of potential compliance risk and opportunity areas. Provide regular periodic reporting to the Board of Directors Audit and Compliance Committee and CEO and senior management about the operations of the Compliance and Privacy Program
    2. Identify and assess areas of compliance risk and opportunities; ensure that the Compliance Program effectively prevents, detects and/or addresses violations of law, regulations and policies. Collaborates with the others to ensure that internal controls are in place to prevent, detect and address significant instances or patterns of illegal, unethical, or improper conduct by employees, agents, affiliated providers, or others. Assures the prompt and proper resolution and implementation of audit or review recommendations. Develops and periodically reviews and updates Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.
    3. Oversee the response to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations.
    4. Ensures retaliation-free reporting channels are available, including the Hot Line, an anonymous telephone reporting system available to all employees, volunteers, affiliated providers and others.
    5. 5. Develop and oversee the strategic auditing and monitoring plan for evaluating the performance of the Compliance Program and related activities to identify risks and initiate appropriate steps to improve effectiveness and mitigate risks.
    6. Acts as an independent review and evaluation body to ensure that compliance Issues/concerns within the organization are being appropriately evaluated, investigated and resolved.
    7. Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
    8. Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
    9. Provides reports on a regular basis, and as directed or requested, to keep the Corporate Compliance Committee of the Board and senior management informed of the operation and progress of compliance efforts.
    10. Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
    11. Establishes and provides direction and management of the compliance Hotline.
    12. Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
    13. Assist internal departments in establishing, maintaining, and updating programs to educate and train managers and other employees regarding applicable state and federal compliance requirements, including HIPAA, and to regularly monitor compliance with those requirements.
    14. Works with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.
    15. Monitors the performance of the Compliance Program and related activities on a continuing basis, taking appropriate steps to improve its effectiveness.

    Qualifications

    1. Minimum Bachelor’s Degree required. Master’s Degree, Juris Doctorate (JD), or other subject matter is preferred.
    2. At least ten years of executive level corporate compliance program experience in the Managed Health Care or Insurance industry participating in government programs (Medicare, Medicaid, Medicare-Medicaid program (“Duals”), Federally Qualified Health Center (FQHC), PACE program, etc.) Experience working with a large, multi-faceted for-profit healthcare organization with a matrixed reporting structure in preferred.
    3. Certification in Health Care Compliance or Compliance is preferred (e.g., CPC, CHC, CPA, CIA or CCEP).
    4. Proven track record in the areas of compliance auditing and monitoring, investigation, risk assessment, enforcement and formulation of comprehensive audit policies, programs, and plans (HIPAA, Medicare, OSHA, etc.)
    5. Must have people leadership experience

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