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In-House
Attorney
Health Care
Litigation - Whistleblower - CFTC
5-10 yrs required
Director, Compliance The candidate provides strategic direction and leadership for compliance, regulatory and risk management activities and management of state contracted services. Determines methodologies to accomplish objectives and ensures compliance with State and Federal regulations, as well as plan and corporate policies and procedures. Responsible for development and implementation of compliance plan and coordination of fraud, waste and abuse (FWA) prevention, detection, investigations and reporting, risk management and regulatory tracking. Serves as the primary contact for all state contract and county oversight deliverables. Serves as the county appointed fraud and abuse coordinator, as required. Ensures accurate reporting of compliance and FWA matters to county contacts. Serves in the capacity of the plan Privacy Officer for HIPAA compliance and assists with other areas of implementation of and adherence to HIPAA requirements. Works closely with the Corporate Compliance and Regulatory Affairs, Enterprise Risk Management, Corporate Financial Integrity Program. Corporate and Financial Investigations management in implementing the plan’s Compliance, Ethics, Privacy and FWA programs. Monitors compliance and provides reports to plan and corporate management.
Qualification and Experience
The candidate should have Advanced degree, J.D. degree preferred, Certified in Health Care Compliance preferred. Must have 5-10 years of experience in managed health care environment, including experience in the areas of compliance, privacy, and fraud, waste and abuse.
Ref: 27841
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