Compliance Manager

Glen Allen VA 23060 Suite 125

Job Description

Serves as the lead compliance and privacy manager at the direction of the Local Compliance Officer for an assigned SBU(s). Oversees regulatory and contract compliance for business managed by MCC of VA. Responsible for supporting the implementation of the SBU Compliance Program, overall HIPAA compliance, risk assessment and executing internal and external audits according to the annual audit plan.
  • Supports the implementation and ongoing operation of the Compliance Program for the assigned SBU(s).
  • Develops and annually updates a formal written compliance program for MCC of VA, and educates the MCC of VA  management team and staff about compliance and the appropriate details of the compliance program.
  • Directs federal and state regulatory and compliance activities at the direction of the Local Compliance Officer.
  • Customizes corporate policies where necessary to address contractual requirements and work with corporate compliance on any customizations that are required due to state regulatory standards.
  • Serves as a liaison for customers on legal and regulatory issues. Supports the Local Compliance Officer with preparing and adminstering the local compliance committee meetings.
  • Generates periodic reports documenting compliance status.
  • Coordinates activities with the Internal Audit and Special Investigations Unit (SIU) on compliance matters including fraud, waste and abuse auditing and monitoring.
  • Ensures corrective actions are implemented for all known compliance deficiencies.  Prepares and may submit reports to the Quality Improvement Committee, Compliance Committee, and the corporate Compliance Department.
  • Attends customer meetings to report on compliance matters.
  • Serves as point of contact for internal and external customers regarding compliance, security, HIPAA, and anti-fraud efforts within MCC of VA.
  • Supports and may execute internal and external audits and reporting.
  • Oversees MCC of VA-delegated entities and their compliance activities and assure that compliance data from the delegated entities are reported to the QIC. 

General Job Information

Title

Compliance Manager

Grade

25

Job Family

Legal Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

9/18/2019

Date Requisition Created

9/18/2019

Work Experience

Quality

Education

Bachelors (Required), Masters

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Knowledge of 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.5-8 years compliance related experience, preferably in health care fieldsExperience working for a Managed Care Company or other health related organization, strongly preferred.Masters degree preferred along with a clinical degree to complete file audits and clinical documentation reviews.Experience and thorough understanding of Microsoft Office, flow charting and other relevant software systems and applications.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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