Download App | FOLLOW US ON SOCIAL MEDIA
 Upload Your Resume   Employers / Post Jobs 

Health Care Attorney in Pittsburgh, PA

University of Pittsburgh Medical Center. Jun 15,2017 May 09,2017 Location Pittsburgh PA
This job is expired...

Public Interest

Attorney

Health Care

Min 5 yrs required

Profile

Senior Director, Medicaid & MLTSS Compliance Responsibilities: Develops, assesses, and adapts clear and effective Medicaid and MLTSS Compliance monitoring, testing, reporting, auditing and sampling protocols, controls and channels to ensure the proper and timely detection of relevant issues. Develops, assesses and adapts clear and effective remediation and corrective action initiatives, protocols and controls to ensure proper and timely compliance. Ensures compliance with required Medicaid and MLTSS laws, regulations, contractual requirements, standards and practices for all relevant stakeholders, both internal and external to the organization. Develops, assesses and adapts clear and effective Medicaid and MLTSS Compliance policies, procedures, training, communications and awareness materials, campaigns, controls and initiatives to ensure clear and consistent understanding and practices throughout internal and external operations to ensure proper and timely preventive measures. Ensures strategic and operational partnership and collaboration with the business and operational areas, as well as with sibling Governance, Risk & Compliance (GRC) teams to leverage cross-departmental synergies and efficiencies. Represents UPMC Insurance Services Division with all relevant regulatory agencies and entities regarding Medicaid and MLTSS Compliance reviews, investigations or requests for information. Keeps abreast of changing industry requirements and regulations, including all relevant laws, rules, contractual agreements, industry standards, company practices and initiatives. Provides clear and effective reports to the relevant business, functional and operational areas, as well as other internal/external stakeholders, regarding new or prospective Medicaid and MLTSS laws, regulations, contractual requirements, industry standards and best practices. Oversees and directs annual and ongoing Medicaid and MLTSS Compliance training to UPMC Insurance Services Division staff and applicable parties. Oversees and directs regular gap analyses, risk assessments and program effectiveness assessments for Medicaid and MLTSS Compliance Programs. Performs other duties as assigned. Effectively lives, models, communicates and supports the values of Health Plan. Performs in accordance with System-wide competencies and behaviors. Represents UPMC Insurance Services Division in all third party- and customer-originating or facing Medicaid or MLTSS Compliance-related reviews, investigations or requests for information. Develops and delivers clear, effective and timely reports and updates for senior management and/or the Board regarding Medicaid and MLTSS Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards and information.

Qualification and Experience

Qualifications: Bachelors degree required. Relevant graduate degree (e.g. JD Degree or Master's Degree in a related field) preferred. 8-10 years of Medicaid and/or LTSS legal and/or compliance experience required, preferably on the insurance (payer) side. Prior in-house legal or compliance experience strongly preferred. Pennsylvania-specific Medicaid and/or LTSS experience preferred, but not required. 3-5 years of work experience in a managerial/leadership role in Medicaid and/or LTSS Compliance. Experience in designing and building highly effective relevant compliance programs from scratch and/or significantly enhancing such programs strongly preferred. Strong subject matter expertise and knowledge of all relevant Medicaid and LTSS laws, regulations, contractual requirements, industry standards and best practices required. Strong acumen and understanding of healthcare, health insurance and managed health care industries and organizations required. Excellent oral, listening and written communication skills. Strong project management skills and experience required, particularly as it relates to managing and leading across large and matrixed organizations. Must have strong analytical and organizational skills as well as problem-solving capabilities to ensure that business plans and strategies do not subject the organization to legal, regulatory or contractual violations and/or undue risk or exposure. Strong partnership, relationship, consensus and coalition-building skills required. Strong emotional intelligence and self-awareness required. Strong executive polish and presence required. Strong strategic, business, operational and leadership mindset and skills required. Highly consultative and partnership-oriented in approach. Strong and reliable judgment and discretion required. Strong ability to independently and self-sufficiently identify, navigate and successfully resolve various Medicaid and MLTSS-related issues. Strong ethical compass and integrity capital required.

Additional info

Job ID: 584732

Company info