Job Information
CareOregon Director, Compliance in Portland, Oregon
Job Title
Director, Compliance
Exemption Status
Exempt
Management Level
Director
Direct Reports
Compliance Team
Manager Title
Vice President, Audit & Compliance
Department
Audit & Compliance
Pay and Benefits
Estimated hiring range $147,600 - $178,600 / year, 10% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits
Posting Notes
This is a hybrid position that will require you to go into the downtown Portland office 3-4 days a year.
Job Summary
This position is responsible for leading the execution of Medicaid and Medicare compliance strategy and activity across the organization. Primary duties include technical and operational planning and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization.
Essential Responsibilities
Technical/Operational Leadership
In coordination with the VP of Audit and Compliance, directs compliance activities across the organization in support of Medicaid, Medicare, and other populations.
Ensures the development and operation of an effective compliance program in accordance with CMS requirements and the Federal Sentencing Guidelines, including:
Monitoring to ensure effective written compliance policies and procedures and Standards of Conduct
Periodic reporting to the organization’s Internal Compliance Committee (senior management) and governing Board of Directors; serve as the Internal Compliance Committee Chair
Providing effective training and education
Establishing and maintaining effective lines of communication at all levels of the organization (to include a non-compliance reporting hotline)
Ensuring consistent enforcement of well-publicized disciplinary standards
Developing and maintaining an effective system for routine monitoring, auditing and identification of compliance risks
Collaborating with other departments to direct compliance issues to appropriate existing channels for investigation and resolution; consults with external attorneys as needed to resolve difficult legal compliance issues
Ensuring there are clear and specific disciplinary policies, procedures, and standards
Develops and monitors an annual compliance work plan.
Reviews and leads the implementation of new requirements outlined by CMS and OHA.
Acts as the primary leader to plan all meetings with external regulatory sources and oversees the organizational compliance calendar.
Ensures the development of sufficient and accurate compliance dashboards used to identify and monitor current compliance and compliance trending of all operational activities.
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.
Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
Provides oversight of the development and maintenance of policies, procedures, structures, and training to support the staff and department into the future.
May serve as a sponsor or chair for key projects and initiatives.
Strategic/Operational Planning
Participates in the development of vision, goals, and strategic plans for Audit and Compliance.
Provides input into the strategic plans of the organization.
Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.
Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.
Financial/Resource Management
Recommends budgets in alignment with short- and long-term plans.
Manages resources to ensure priorities are accomplished.
Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.
Relationship Management
Leads effective communication system for work group(s), ensuring a collaborative culture.
Builds and ensures effective relationships across internal teams and external organizations for current or future integration.
Partners with internal leaders and managers in identifying improvement plans and processes.
Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.
Employee Supervision
Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.
Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.
Identifies department priorities; ensures employees have information and resources to meet job expectations.
Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.
Manages, coaches, motivates, and guides employees; promotes employee development.
Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.
Ensures team adheres to department and organizational standards, policies, and procedures.
Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).
Performs supervisory tasks in collaboration with Human Resources as needed.
Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision and values.
Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.
Experience and/or Education
Required
Minimum 10 years’ experience in regulatory, compliance, and/or audit, including at least 8 years’ experience in healthcare
Preferred
Minimum 4 years’ experience in a supervisory position
Leadership experience in a managed care organization
Knowledge, Skills and Abilities Required
Knowledge
Knowledge of managed healthcare operations
Knowledge of State and Federal compliance plan requirements for Medicare and Medicaid Programs
Knowledge of HIPAA Privacy and Security laws, practices, access, release information and release control technologies
Knowledge of the Patient Protection and Affordable Care Act
Knowledge of OAR’s and their purpose
Basic understanding of information systems
Knowledge about how the functions of a business work and relate to one another
Skills and Abilities
Ability to perform or oversee the performance of risk assessments and/or gap analysis
Ability to facilitate learning opportunities in a variety of informal and formal settings
Ability to make presentations to small and large groups
Ability to think logically and creatively without undue influence from personal biases
Ability to build conceptual models and communicate complex ideas effectively
Ability to plan, organize, manage, and monitor work projects
Excellent written and verbal communication skills
Investigative skills
Strong interpersonal skills
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to for at least 3-6 hours/day
Working Conditions
Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure
Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person
Hazards: May include, but not limited to, physical and ergonomic hazards.Equipment: General office equipment
Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.
Veterans are strongly encouraged to apply.
We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.
Visa sponsorship is not available at this time.