Sr Director, Compliance Officer - Brooklyn, NY
Brooklyn NY 11201 Brooklyn 3 15 MetroTech Center SWH
Job DescriptionResponsible for the development, implementation, oversight and administration of business unit specific compliance program(s). This position also serves as the primary contact for compliance communications for Magellan. The Compliance Officer is responsible for ensuring overall compliance with all pharmacy-related activities and programs. Promotes an awareness and understanding of positive ethical and moral principles consistent with the mission, commitment, and core values of the organization and those required by federal and state law.
- Develops, implements and oversees business unit compliance program
- Serves as the primary compliance contact and is responsible for ensuring overall compliance with compliance requirements
- Coordinates implementation of system-wide programs, policies, and procedures to ensure system compliance with applicable federal and state laws and regulations
- Responsible for organizational compliance with transmittals, HPMS notices, required applications and submissions. Maintains HPMS information, as appropriate
- Implements, and maintains a system for confidential reporting and investigation of compliance concerns with an appropriate response process.
- Builds a risk-based compliance monitoring program, including a system for identification of compliance issues as well as tracking, remediation and documentation of such issues
- Coordinates with legal counsel in response to identified compliance questions, concerns, or federal/state inquires or investigations.
- Directs efforts to communicate compliance programs, including written materials and training programs designed specifically to promote understanding of compliance issues, laws and regulations, and consequences of non-compliance
- In coordination with legal counsel, maintains awareness of laws and regulations, keeping abreast of current changes that may affect health care systems.
- Reviews reported issues, concerns, or questions relative to compliance matters. Provides consultative leadership and support to all entities as appropriate. Includes close coordination with all levels of management throughout the Company
- Develops, implements, oversees a monitoring program to monitor internal processes and external entities for compliance with applicable laws, regulations and program guidance
- Produces and analyzes routine and ad hoc operational monitoring reports; provides regulatory and operational subject matter expertise, for analysis of policy and interpretation, testing monitoring and adherence to requirements
- Supports the development of regulatory and operational business requirements for best practice and implementation of applicable state and federal laws and CMS rules and regulations
- Coordinates the development, implementation, and maintenance of audit controls and measurements for internal and external processes; ensuring correct processes are in place for accurate, complete, and compliant programs across the system including First Tier, Downstream and Related entities (FDRs).
- Works cross-functionally to ensure identified non-compliance is remediated
- Communicates to and works collaboratively with the Chief Executive Officer, the Board of Directors, the Corporate Compliance Officer and in-house Legal counsel.
- Prepares monthly and/or quarterly compliance summaries for the organizations leadership, as outlined above, as well as the Compliance Committee
- Ensures that disciplinary action is conducted in an appropriate and uniform manner.
- Provides guidance as needed on Magellan's Medicare Advantage First Tier Entity Compliance Programs.
General Job Information
TitleSr Director, Compliance Officer - Brooklyn, NY
Job FamilyLegal Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date1/31/2020
Date Requisition Created1/31/2020
Work ExperienceCompliance, Quality
EducationBachelors (Required), GED, High School
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
ResponsibilitiesMinimum Requirements?Education: BA/BSField(s) of study: Health Care Administration, regulatory/legal, business or other related field.Experience: 8+ yearsJob Specific: At least eight years experience in managed care, health company and/or government healthcare Compliance programs including experience in operating Medicare Advantage compliance programs required.Education and/or experiences may run concurrent.Other?Ability to work independently and prioritize activities.Knowledge, Skills, Abilities: Excellent written and verbal communication skills.Computer Skills: MS Office proficiency, experience with provider systems preferred.Licenses and certifications: Certification in Healthcare Compliance preferred.Preferred Qualifications?Education: Advanced Degree preferred.Experience: Solid experience in managed care, health insurance company and/or government healthcare Compliance Programs. 8+ years experience directly managing a Medicare Advantage Compliance Program Knowledge, Skills, Abilities: Knowledge of federal healthcare laws, regulations and guidance regarding compliance programs for federally funded healthcare programs. Solid Knowledge of CMS, Medicare Part C and Part D regulations.Ability to work independently, manage multiple projects and meet scheduled deadlines Ability to identify root cause issues and ensure appropriate corrective actions. Strong analytical and organizational skills with attention to detail. Ability to effectively communicate issues, findings, and recommendations both verbally and in writing to all levels of management. Proficiency in applying and interpreting rules associated with Medicare regulations and CMS, and AHCCCS and DBHS applications and tools. Experience in leading and partnering with cross functional teams to accomplish a common goal.
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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