Associate Vice President, Compliance Implementation(Managed Care Experience Required)

Job Summary:

The Senior Director, Compliance - Growth and Implementation is responsible for supporting the organizations new market growth and provide compliance oversight and guidance related to significant regulatory implementations.

Essential Functions:

• Assist with new market Medicaid expansions including regulatory guidance, policy and procedure drafting, readiness review and other implementation requirements
• Assist with existing market Medicaid new contract implementations including regulatory guidance, policy and procedure drafting, readiness review and other implementation requirements
• Provide compliance assistance to the operational and implementation teams to oversee effective readiness for the expansion of Medicare and Marketplace lines of business  
• Collaborate with the compliance team members to keep compliance team members informed of status of implementation and readiness activities
• Draft at least quarterly status reports for the Corporate Compliance Officer/Committee and Enterprise Executive Leadership regarding implementation efforts and product expansion efforts
• Direct periodic department or line of business compliance reviews to assess implementation efforts with regulatory requirements including company policies, state and federal laws and regulations
• Direct and/or assist in the development of KCIs and other key metrics related to key Medicaid contractual requirement and Medicare and Marketplace requirements in new markets
• Identify areas of risk requiring the establishment or enhancement of internal controls, policies and procedures, products and/or services, and training associated with any compliance obligations
• Maintain positive and strategic relationships with internal and external stakeholders
• Provide management and oversight of professional staff
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in business or related field or equivalent years of relevant work experience is required
• MBA or JD strongly preferred
• Minimum of seven (7) years of healthcare operations or clinical experience or providing counsel to same, including three (3) years in Government Program products is required
• Minimum of five (5) years of Compliance Program leadership experience or five (5) years health plan quality program experience is required with focus on compliance audit/monitoring activities is required
• Minimum of three (3) years previous management experience is required, compliance oversight leadership experience within healthcare operations is preferred
• Significant regulatory implementation experience is required
• Support new market expansions is preferred

Competencies, Knowledge and Skills:

• Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid/Marketplace and Medicare)
• Exceptional project management skills
• Strategic management and leadership skills
• Ability to work independently and within a matrixed environment
• Attention to detail and strong communication skills necessary
• Demonstrated critical listening and thinking skills
• Negotiation skills
• Time management skills including creation and maintenance of project timelines
• Decision making/problem solving skills
• Advanced level experience in Microsoft Word, Excel and PowerPoint

Licensure and Certification:

• Certified in Healthcare Compliance (CHC) preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.