Director of Risk Management and Contractual Compliance

Albuquerque NM 87113

Job Description

Serves as compliance and privacy officer. Oversees legal and regulatory compliance and contract compliance for all State business, including Medicaid and commercial business. Provide consultation as necessary to Compliance Officers with regard to State compliance issues.
  • Oversees the implementation and ongoing operation of the Compliance Program.
  • Develops, implements and annually updates a formal written compliance program, and educates the management team and staff about compliance and the appropriate details of the compliance program.
  • Assists in preparation of regulatory filings and reports to regulatory agencies.
  • Serves as a liaison for customers on legal and regulatory issues.
  • Ensures corrective actions are implemented for all known compliance deficiencies.  
  • Serves as Company liaison with State regulators.
  • Meets with state regulators as necessary and serves as their point of contact for all company and its affiliate's issues. 
  • Maintains expertise related to authorization and non-authorization correspondence requirements from the perspective of ERISA, NCQA, URAC, federal regulations, and state law. 
  • Maintains a working knowledge of customer contractual requirements and state Medicaid contract requirements.
  • Ensures business unit is in compliance with these contractual standards. 
  • Implements appropriate programs to prevent, monitors and detects fraud, waste and abuse. 
  • Serves as central contact for internal and external customers regarding compliance, security, HIPAA, and anti-fraud efforts.
  • Leads internal and external audits and reporting.
  • Oversees and ensures that all applicable new laws and regulations and changes to existing laws and regulations affecting the organization are implemented
  • Ensures appropriate customization of corporate policies to comply with State law and regulations, and customer contracts.
  • Develops and implements any additional written policies, procedures, protocols and standards of conduct necessary to comply with all applicable State laws and regulations and terms of the customer contracts and state Medicaid program requirements.
  • Ensures that these policies are being followed by operational staff.

General Job Information

Title

Director of Risk Management and Contractual Compliance

Grade

29

Job Family

Legal Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

1/8/2019

Date Requisition Created

1/8/2019

Minimum Qualifications

Education

Bachelors (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 5+ years related experience in health care field, preferably New Mexico system.
  • Experience and thorough understanding of word processing, flow charting, and archiving and other relevant software systems and applications.
  • Knowledge of New Mexico law, HIPAA, federal and state regulatory processes.
  • 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.

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

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