What are the responsibilities and job description for the Director of Federal and Integrated Product Compliance position at MetroPlus Health Plan?
Director of Federal and Integrated Product Compliance
Job Ref : 118372
Category : Compliance and Regulatory
Department : OFFICE CORPORATE COMPLIANCE
Location : 50 Water Street, 7th Floor, New York, NY 10004
Job Type : Regular
Employment Type : Full-Time
Hire In Rate : $155,000.00
Salary Range : $165,000.00 - $165,000.00
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health Hospitals
MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
The Director of Federal and Integrated Product Compliance, reporting to the Vice President of Compliance, plays an integral role in the oversight and management of product regulatory compliance activities for federal and integrated products offered by MetroPlus Health including Medicare, MAP, MLTC and IB Duals. Overseeing a team of product compliance specialists, this role is responsible for monitoring all related regulatory guidance and implementations for compliance, supporting the organization with corrective actions and regulatory disclosures, and contributing to the annual compliance risk analysis and work plan.
Job Description
- Oversees a team of product regulatory compliance specialists for Federal and integrated products offered by MetroPlusHealth.
- Contributes to the annual Plan risk assessment, collaborating with the various Compliance teams, to assist the enterprise in identifying areas with potential compliance issues.
- Supports the completion and presentation of the Annual Compliance Work Plan and oversees completion of auditing and monitoring projects assigned to the Federal and Integrated Product Compliance Department.
- Develops, implements and revises policies and procedures for the Regulatory Compliance Department.
- Responsible for the day-to-day operations of the Federal and Integrated Product Compliance Unit.Prepares and updates materials for compliance committees including the Vendor
- Delegation Oversight Subcommittee, Compliance Committee, and Audit and Compliance Committee of the Board of Directors.
- Provides implementation oversight by ensuring regulatory requirements have been effectively implemented by the internal and external business areas for Medicare, MAP, MLTC and IB Duals.
- Ensures open lines of communication, both internally and externally, so any reports of potential non-compliance are received and investigated.
- Assists in the identification and resolution of noncompliance issues. Upon identification, provides support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance review. If self-disclosure is required, compiles and prepares necessary information.
- Assists business areas in creating and updating monitoring metrics to assess continued compliance with regulatory requirements.
- Manages annual external audit of the Compliance Program as required by regulation, to include evaluation of both the Medicare and MAP Compliance Plans and collaboration with Corporate Compliance for evaluation of fraud, waste, abuse, privacy and record retention functions.
- Serves as a voting member of the Vendor Delegation Oversight Subcommittee; providing Compliance advisement and ensuring all delegate related non-compliance issues / trends are reported. Participates in auditing and monitoring functions of downstream entities.
- Other duties as assigned or requested.
Minimum Qualifications
Licensure and / or Certification Preferred
Professional Competencies
LI-Hybrid
MHP50
Salary : $155,000 - $165,000
