Nov 13, 2019
WellCare Health Plans LOCATION: Ohio DEPARTMENT: Compliance REPORTING TO: Sr Dir, Market Compliance Officer Assists with the implementation of policies, procedures, and practices designed to ensure compliance with the requirements set forth in federal and state Plan contracts, laws, regulations, and health care program requirements. Serves as the contact for the Sr Director on compliance and ethics activities in the Market. Functions as the local contact for the Corporate Compliance Department's functional units and serve as a Market resource for identifying, tracking, mitigating and reporting on operational compliance risks. Essential Functions: Implements and oversees the policies, procedures and practices designed to ensure compliance with the requirements set forth in federal and state Plan contracts, laws, regulations, and health care program requirements. Serves as the Market's subject matter expert on the conditions and terms of WellCare's federal and state contracts. Establishes and leads the Market Compliance Oversight Committee. Ensure meeting minutes are collected and archived. Completes Market Compliance Assessments - Quarterly Performance Report Work plan and compile Quarterly Performance Report for submission to Market leader and Sr Director, Market Compliance Officer.s Partners with Internal Audit Department on Market-based assessments Guides the escalation path within the market for compliance related and ethical issues and involve the appropriate resources and support from Corporate Compliance. Conducts and tracks on-site compliance trainings and provide updates to the field organization. Serves as Market subject matter expert for HIPAA, assess compliance with HIPAA requirements, performs periodic HIPAA audits of office locations and guide remediation plans. Serves as the local compliance and oversight contact for Compliance applications (LIONS, C360). Collaborates with Regulatory Affairs to remain current on state regulations, comply with reporting requirements and serve as an integrated compliance voice during the planning and execution phases of Market programs and projects. Communicates the status of key compliance activities, new and emerging compliance issues and compliance metrics by regularly participating in Market leadership meetings and consulting with leaders as needed. Participates in regularly scheduled one on one meetings with Market leader. Serves as the Market compliance resource and assist the Sr Director, Market Compliance Officer with monitoring the day-to-day compliance activities at the applicable Market Collaborates with Market Leadership to identify risks and monitor processes to ensure compliance with state and federal health care program requirements. Consults with business owners of contract requirements and electronically validate their contract assessments in the Corporate Compliance system. Performs validation reviews and risk assessments to evaluate compliance contract requirements and business processes. Monitors contract uploads in Corporate Compliance system to ensure all requirements documented including amendments, handbooks, policy transmittals and statutes. Collaborates with Market Regulatory Affairs, Delegation Oversight and Legal departments to monitor vendor compliance. Review delegation oversight tools, subcontracts and provider agreements to ensure they meet regulatory requirements. Reviews and conducts assigned delegation oversight audits. Prepares, monitors and drives remediation of identified risks. Builds relationships with key business owners to collect and review operational reports to monitor compliance and communicate risks. Communicates risk information and performance scores to Market leaders, Vice President, Compliance Oversight, Market Regulatory Affairs, Internal Audit, and Directors, Market Compliance peers. Provides oversight of the internal and external audit process including: risk assessment, external audit management, preparation and facilitation. Performs targeted reviews of operational and contractual compliance. Partners with Compliance Investigation teams, including conducting investigations relative to agent Sales & Marketing and enrollment FWA cases and conducting interviews with potential beneficiaries, members, agents, providers, associates and/or downstream entities as required for investigatory purposes. Monitors results of internal and external audits, escalated issues, notices of non-compliance, warning letters, non-audit CAPs, fines, penalties, liquidated damages or sanctions. Provides oversight for monitoring and tracking of Market Compliance Program metrics, structure, process and oversight. Performs other duties as assigned. Additional Responsibilities: In some markets, MCO may have direct people leader responsibilities Candidate Education: Required A Bachelor's Degree in Related Field Required Other an additional 2 years of applicable experience may substitute for the Bachelors Degree Preferred A Master's Degree in Business Administration, Public Health, or Healthcare Administration Candidate Experience: Required 5 years of experience in Corporate compliance, regulatory affairs or state government Preferred 1 year of experience in managing and leading teams Preferred Other Managed care Candidate Skills: Intermediate Ability to drive multiple projects Intermediate Ability to work within tight timeframes and meet strict deadlines Intermediate Demonstrated written communication skills Intermediate Ability to effectively present information and respond to questions from peers and management Intermediate Ability to work in a matrixed environment Intermediate Demonstrated interpersonal/verbal communication skills Intermediate Knowledge of community, state and federal laws and resources Intermediate Ability to influence internal and external constituents Intermediate Ability to represent the company with external constituents Intermediate Ability to work independently Intermediate Demonstrated ability to deal with confidential information Intermediate Other use keen judgment in difficult situations, balancing the competing interests of corporate and regional offices in a matrix management system Intermediate Other developing and delivering training programs Licenses and Certifications: A license in one of the following is required: Preferred Other Certified in Healthcare Compliance (CHC) Technical Skills: Required Intermediate Microsoft Excel Required Intermediate Microsoft Outlook Required Intermediate Microsoft Word Required Intermediate Microsoft PowerPoint About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Professional Diversity Network Columbus, OH, USA Full-Time