What are the responsibilities and job description for the Director, Operations Regulatory Oversight position at CareSource?
Job Summary :
The Director, Operations Regulatory Oversight is responsible for representation and leadership of all regulatory and compliance activity on behalf of the Operations division. This Sr. Level leader serves as liaison to and works in collaboration with the enterprise Regulatory and the CareSource Compliance program on all Operations issues, risks, and preventative activity.
Essential Functions :
- Liaison with all internal area leaders Enterprise wide for compliance, regulatory, and audit functions on behalf of Claims, Configuration, Enrollment, Payment Integrity, Grievance & Appeals, Encounters, and Provider & Member data
- Collaborate with Operations leaders to proficiently represent Operations both internally and externally to Regulators and Auditors as appropriate for all audit, regulatory, and compliance issues in coordination with Compliance and / or Audit Departments.
- Work with impacted operational business areas, Regulatory, and Legal to help ensure proper interpretation and implementation of such laws, regulations, guidance, contracts and similar regulatory requirements as identified by Market Regulatory and Corporate Compliance
- Maintain compliance, audit, and regulatory tracking and monitor issues through completion
- Monitor and review regulatory and legislative requirements and changes; respond to requests, audits, and investigations, communicate and implement regulatory requirements, and follow-up with appropriate areas to ensure required changes are effectively implemented
- Draft initial operational responses to the state, department of insurance and other regulatory agencies including internal stakeholders in a prudent layperson language so as to support easy understanding of the content and in a timely manner
- Ensure direct line leadership and the Corporate Compliance Officer are informed of all material regulatory initiatives, compliance concerns, operational issues and associated corrective actions / remediation impacting CareSource
- Accountable for Operations status reporting to Corporate Compliance Officer / Committee
- Maintains strong relationships with key leaders and business partners to identify and address compliance risks and manage action plans designed to fully mitigate compliance risk(s).
- Perform any other job duties as requested
Education and Experience :
Competencies, Knowledge and Skills :
Licensure and Certification :
Working Conditions :
Compensation Range :
110,800.00 - $193,800.00 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. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type : Salary
Competencies :
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.
Salary : $110,800 - $193,800