EXECUTIVE DIRECTOR COMPLIANCE (Knox-Keene Experience Required) in Cypress, CA at Beacon Health Options

Date Posted: 6/1/2018

Job Snapshot

Job Description

ABOUT THE POSITION

We are currently seeking a dynamic AVP of Compliance to join our team at our office in Cypress, CA.  The AVP of Compliance will be responsible for managing all ValueOptions of California oversight activities required for compliance with the rules and regulations of the California Knox-Keene Health Care Service Plan Act and amendments and the requirements of the Department of Managed Health Care (DMHC), from implementation to full compliance.  The position will also evaluate federal compliance activities to determine how they interrelated with Knox-Keene regulations and DMHC requirements.  A strong understanding of managed care operations will be a key asset for the position. In additional, this position will help the region to determine how to interpret APL’s and other regulations that come down to Beacon through our State or Federal regulators.

Position Responsibilities:

  • Project management and oversight of compliance projects from Knox-Keene regulations and DMHC requirements.

  • Identify Knox-Keene requirements affecting new client implementations and coordinate activities with Plan and regional operating departments.

  • Coordinate quarterly Public Policy committees.

  • Develop strategic plan for VOC to ensure compliance with Knox-Keene act regulations and DMHC requirements.

  • Coordinate maintaining procedural documentation for all VOC departments to ensure the Plan’s compliance with Knox-Keene regulations and DMHC requirements.

  • Assists in the evaluation of the adequacy and effectiveness of compliance and regulatory policies and procedures. Includes recommending and implementing appropriate changes to operating policies and procedures.

  • Implements, documents, and maintains a coordinated legislative and regulatory tracking program in support of Medicaid clients.

  • Researches and provides technical assistance for state and Federal regulatory rules and regulations related to Medicaid and prepares guidance documents as necessary to support operational compliance.

  • Assists in the investigations of alleged ethical violations.

  • Responsible for the oversight, administration and implementation of the site specific compliance committee and acts as the committee chairperson.

  • Coordinates and communicates all compliance related state coordination activities to the committee, including performance measures, trend analysis, corrective actions, risk analysis and technical assistance.

  • Develops and presents compliance related training.

  • Serves as a technical advisor in the design of new reports and enhancements to existing reporting systems.

  • Responsible for the accurate and timely creation of site specific compliance reports.

  • Assists in the creation, modification and implementation of policies, procedures, methods and systems required for site specific. Works in conjunction with the Regional Chief Operation Officer and team to develop, implement and enhance enterprise-wide approaches to compliance.

  • Adheres to all Beacon policies and procedures and standards of operations.

  • Completes all required and assigned trainings.

  • Attends all mandatory company or department meetings.

  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

  • Identify misconduct and finds resolution and escalate to Human Resources.

  • Travel to all company sponsored events, trainings, and locations based on business needs.

  • Performs special projects and other duties as assigned and required.

    Position Requirements:

    Education: Bachelor’s degree required in healthcare or related field.  Master’s degree preferred.

    Relevant Work Experience:  

    Minimum five years’ experience in healthcare regulatory and DMHC and Knox Keene compliance activities. This position requires demonstrated problem solving ability.

    Licensure:

    Valid Driver’s License

    Knowledge, Skills & Abilities:

  • Knowledge of business acumen and an understanding of the managed care industry

  • Knowledge of Medicare & Medi-Cal

  • Skill in group presentation and public speaking

  • Excellent written and oral communication skills

  • Self-motivated, able to prioritize multiple issues, excellent organizational skills and attention to detail, ability to track multiple projects/tasks and follow through as needed

  • Ability to manage and coordinate with internal and external departments

  • Ability to identify and act on opportunities for improvements and recommend and implement innovative solutions

  • Able to work collaboratively with internal staff and external stakeholders (provider organizations, clients, etc.)

  • Ability to identify and resolve emerging issues and/or escalate to management in a timely manner

  • Ability to maintain privacy and confidentiality in compliance with HIPAA regulations and policies

TO APPLY

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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled

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