MANAGER, COMPLIANCE

Job Summary:

Reporting to Vivant Health’s (Vivant) Compliance Officer, the Compliance Manager ensures all required elements of an effective Compliance Program are met. This position is responsible for assisting with the execution of Vivant’s compliance plan and the organization’s compliance education program.  The Compliance Manager will be responsible for delegation oversight activities from sponsoring health plans as well as developing and implementing a communication plan to achieve consistently high levels of compliance with state and federal regulations, statutes, laws, and contractual obligations throughout the organization. 

Responsibilities:

• Serve as a Subject Matter Expert in health care compliance and maintain a current knowledge of healthcare legal and regulatory requirements and industry standards.
• Assists the Compliance Officer in establishing and maintaining an effective, comprehensive Compliance and Privacy Program.  
• Research Federal and State regulations and payor contract requirements on assigned compliance topics.
• Partners and collaborates with the Compliance Officer, senior leadership, and legal counsel to communicate and implement guidance on all new regulations, contractual requirements, and current business initiatives.
• Assists in the management of the day-to-day compliance program.
• Assists in the development, modification, communication, and implementation of policies and procedures.
• Assists in the development and execution of annual compliance and monitoring plans, including performing the risk assessment and implementing corrective action plans where needed.
• Manages Vivant’s day-to-day delegation oversight requests, audits, and communications from the sponsoring health plans.
• Works with Compliance, Legal, IT, and HR to maintain compliance education and training materials.
• Supervises front line Compliance staff, including but not limited to the Compliance Analyst and other front line compliance staff to achieve the desired outcomes.

 Competencies

• 3 years of experience in healthcare compliance at a Medi-Cal managed care focused Independent Physician Association (IPA), medical group, or health plan is strongly preferred.
• Current expertise in Medi-Cal and DMHC/DHCS regulations/requirements/standards is required.   Medicare Advantage knowledge is preferred.  
• Knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
• Demonstrated track record of serving in increasingly responsible compliance positions and working collaboratively and effectively with others.  
• Experience in leading or participating in healthcare vendor, customer, or provider relationship management.
• Strong oral and written communication skills, with the ability to communicate professionally with diverse individuals and groups inside and outside of Vivant.
• Consistently exercise sound judgment, and strict maintenance of confidentiality.  
• Proactively and effectively solve problems.  
• Builds partnerships and works collaboratively with others to meet shared objectives.
• Collaboration with others, and development of partnerships and good working relationships.  
• Excellent attention to detail, multi-tasking, time management, project management, and organization skills. Microsoft software (Word, Excel, PowerPoint) expertise.   

Education and Licensure

• Associate degree in relevant field or unrestricted LVN license required. BA/BS in related field preferred. Relevant equivalent combination of education and experience may be considered in lieu of degree.
• Certification Health Care Compliance (CHC) highly preferred.
• PMP and/or Lean/Six Sigma certification preferred

Travel

The incumbent may travel up to 5% of the time.

Work Environment

This job operates in a professional office environment.  This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.