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Director of Corporate Compliance and Privacy

Company: MetroPlus Health Plan
Location: New York
Posted on: September 25, 2022

Job Description:

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 + HospitalsMetroPlusHealth 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, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth -has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position OverviewThe Director of Corporate Compliance and Privacy, reporting to the Senior Director of Compliance Operations, plays an integral role in the oversight and management of our Corporate Compliance, Vendor Compliance and Privacy Programs. Overseeing a team of compliance analysts, this role is responsible overseeing daily operational and functional requirements of the programs related to this area.Job Description

  • Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives. Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance.
  • Oversee the Corporate Compliance and Privacy investigations. Ensuring timely completion. Essential to this role is the ability to track and trend emerging issues and how we may be able to respond on an organizational level.
  • Respond to questions and concerns relating to general corporate compliance, privacy and vendor compliance matters, including exclusion screening, fraud, waste and abuse concerns, institutional gift policy, etc.
  • Supporting the annual plan risk assessment and collaborating with the Regulatory Compliance team, to assist in identifying areas with potential compliance issues and develop work plan activities.
  • Track and trend corrective action plans (CAPs) related to all areas of responsibility. Ensuring CAPs are addressed and closed in a timely manner. Be able to identify systemic issues and work with the Sr. Director to develop solutions.
  • Manage ongoing relationship with the Special Investigations Unit internally as well as with our delegated vendors performing FWA activities. This includes: Leading monthly meetings, ensuring ongoing collaboration and developing solutions as issues arise.
  • Review and confirm the accuracy of the data we are submitting to external agencies from both Corporate Compliance and Privacy.
  • Compile and finalize reports from areas of oversight for internal reporting purposes. Includes: Vendor Delegation Oversight, Compliance Committee, Fraud, Waste and Abuse Committee, and Audit and Compliance Committee. Work with the Senior Director to develop agenda and highlight issues that must be brought to the attention of the Committees.
  • Develops and/or ensures that internal controls are implemented to prevent and detect instances or patterns of illegal, unethical, or improper conduct.
  • Serving as participating member of the Vendor Delegation Oversight Committee, the Fraud, Waste and Abuse Committee and the Compliance Committee representing Corporate Compliance, Privacy, and FWA concerns.
  • Leads response efforts for regulatory filings, audits, and other oversight activities by regulators.
  • Monitor key elements of the Corporate Compliance, Vendor Compliance, and Privacy Programs and ensure supporting policies and procedures are reviewed and updated on an annual basis and as needed.
  • Keeping up to date on the latest developments and federal and state laws and regulations.
  • Assisting with development and implementation of training programs for members of the workforce addressing compliance, privacy, and FWA related topics.
  • Provides direct management of the Senior Corporate Compliance Analyst, Privacy Analyst, and Senior Vendor Compliance Specialist.
  • Other activities as assigned by the Senior Director or Chief Compliance and Regulatory Officer.Minimum Qualifications
    • Bachelor's degree in a health-related field.
    • Minimum of 7 years of experience in healthcare compliance.
    • Preferred candidate will possess:
      • Master's degree in business/public administration or public health.
      • Health insurance plan and/or health care industry work experience.
      • Knowledge of Medicaid, Medicare, Affordable Care Act, and HIPAA.
      • Knowledge and experience in information privacy laws; access and release of information; FWA standards; and principles of change management.
      • Excellent analytical, organization, and oral and written communication skills.
      • Expertise with Microsoft Office Suite.Licensure and/or Certification Required
        • -CHC, CHPC, and/or CCEPProfessional Competencies
          • Integrity and Trust
          • Customer Focus
          • Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles. The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
          • Experience with managed care, Medicare and federal and/or state regulations, quality improvement and compliance oversight.
          • High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
          • Simultaneously manage multiple projects.
          • Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences
          • The utmost integrity in the discreet and confidential handling of confidential materials is necessary
          • Demonstrated knowledge of managing and building relationships with stakeholders, including senior management, with strong influencing and negotiation skills.
          • Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team.
          • Sound working knowledge of Windows-based software packages, including Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools.

Keywords: MetroPlus Health Plan, New York , Director of Corporate Compliance and Privacy, Executive , New York, New York

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