Healthcare News
Articles, Jobs and Consultants for the Healthcare Professional
Home      View Jobs     Post Jobs     Library     Advertise     Plan Financials     About     Subscribe     Contact    

Compliance Manager, South San Francisco, CA


Organization: Health Plan of San Mateo
Category: Manager
Location: South San Francisco, CA
Date Job Posted: January 10, 2020
Share with Others:


COMPLIANCE MANAGER

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Compliance Manager to promote and ensure compliance with various requirements, including but not limited to contractual and regulatory obligations, through the design and implementation tools, processes and systems to prevent, detect and deter non-compliance. The Compliance Manager focuses on risk based and peer informed activities that protect HPSM’s reputation, ensure high quality and integrity of business operations, and ensure HPSM is able to meet its mission and vision.

The essential duties and responsibilities will include the following:

  • Partners with Chief Compliance Officer (CCO) to ensure assigned Compliance Program activities and controls are implemented based on communication, collaboration, and transparency within the organization.
  • Establishes and maintains effective relationships with peers and stakeholders, internal and external to the organization, to ensure assigned compliance controls, activities, goals and objectives enable the organization to achieve its mission and vision.
  • Serves as the organization’s Privacy Officer; establishing and maintaining a comprehensive privacy compliance program consistent with state and federal law, in consultation with the Security Officer and Chief Compliance Officer that is responsive to the organization’s needs, organization-specific risks and external risk factors.
  • Ensures the annual risk assessment accurately reflects internal audit and investigations experience to proactively mitigate risks, and ensure controls are implemented to prevent, detect and deter non-compliance.
  • Implements, monitors and ensures success of: (a) an internal audit program designed by a risk assessment which meets organizational needs including maintenance of NCQA accreditation, and (b) an investigation program to identify, receive and respond to issues of Fraud, Waste, Abuse (FWA), non-compliance and privacy.
  • Oversees the preparation of corrective action plans related to performance management, including but not limited to internal audits and issues of non-compliance, and monitor their implementation.
  • Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; coordinating and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner.
  • Designs goals and objectives for assigned staff based on organizational and department goals; collaborates with Chief Compliance Officer on design of department-specific goals and objectives.
  • Represents compliance and privacy concerns on organizational committees, including but not limited to: Compliance Committee, Delegation Oversight Subcommittee, FWA Subcommittee, Audit Work Group, P&P Committee, Data Governance Council, and others as requested. Participates with a goal of working collaboratively to meet the organization’s mission, vision and goals.
  • Maintain current knowledge of the business and regulatory environment relative to the business and regulatory environment.
  • Serve as a resource on relevant laws and regulations and stay current with changes that may affect HPSM’s programs.
  • Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows.
  • Perform other duties as assigned

Requirements

Education and Experience: Bachelor’s Degree in public health, policy, or administration; advanced degree preferred. Five (5) or more years related experience in government programs, particularly Medicare and in managed care environment. Minimum of two years supervisory experience.

Knowledge of: Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint. Managed care and strong familiarity with the health care field. Regulatory and or compliance processes impacting managed health care. Principles and methods of planning, directing and maintaining compliance with regulatory standards. Managerial/Supervisory principles and practices as well as techniques and methods to organize and manage a department. Principles and practices of managed care health care systems, medical administration and NCQA accreditation standards.

Ability to: Work cooperatively with others. Work as part of a team and support team decisions. Communicate effectively, both verbally and in writing. Adapt to changes in requirements/priorities for daily and specialized tasks. Display professional communication skills (both written and oral) and possess a high level of attention to detail. Demonstrate superior organization, facilitation, and presentation skills. Build and maintain strong relationships within and outside HPSM. Impart critical thinking, listening, time management, decision making, and problem solving skills; maintain confidentiality. Think and work effectively under pressure and accurately complete tasks within established times; prioritization and meeting critical deadlines. Work independently and within a team environment as well as work collaboratively across functional areas in a matrix structure. Effectively train and provide customer service skills in accordance to various audiences and comprehension levels. Exhibit strong interpersonal skills to utilize when coaching staff and handling conflict resolution

Compensation and Benefits

Starting Compensation Range: - Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s Medical, Dental and Vision coverage. Employee pays a small portion of the dependent premiums (5%) for medical and dental benefits. Additional HPSM benefits include fully paid life, AD&D, and LTD insurance; retirement plan (HPSM contributes equivalent of 10% of annual compensation); holiday and vacation pay; tuition reimbursement plan; onsite fitness center and more.

How to Apply

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. The Health Plan of San Mateo is proud to be an Equal Opportunity Employer and encourages minority candidates of all backgrounds to apply.

Submissions without a Cover Letter and Salary Expectations may not be considered.


See above

See above

See above