This Compliance Officer II position is available as a remote opportunity from anywhere in California.
Responsible 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 business unit related activities and programs. Promotes 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, state regulatory guidance, HPMS memoranda, required applications and submissions. Maintains state and federal 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 business unit and 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 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 subcontractors and First Tier, Downstream and Related entities (FDRs).
- Works cross-functionally to ensure identified non-compliance is remediated.
- Communicates to and collaborates with the Chief Executive Officer, the Board of Directors, the Chief Compliance Officer and in-house Legal counsel.
- Prepares monthly and/or quarterly compliance summaries for the organization’s 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 state and federal Compliance Programs.
Other Job Requirements
Responsibilities
Healthcare software and word processing experience.
Extensive knowledge of federal, state, and payer-specific regulations.
Strong leadership, interpersonal, and critical thinking skills.
Excellent written and verbal communication skills.
Proven ability to effectively represent company and program interests to government regulators.
Demonstrates personal traits of a high level of integrity, team orientation, professionalism, and trustworthiness.
Places a high value on ethical standards and treating others with dignity and respect.
General Job Information
Title
Compliance Officer II - Remote from California
Grade
32
Work Experience - Required
Compliance, Quality
Work Experience - Preferred
Education - Required
A Combination of Education and Work Experience May Be Considered., Bachelor's
Education - Preferred
JD, Master's - Healthcare
License and Certifications - Required
License and Certifications - Preferred
Salary Range
Salary Minimum:
$127,295
Salary Maximum:
$229,105
This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.
Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.
