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Compliance Manager

Job Type : Direct
Hours : Full Time
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Other

Job Description :

The Compliance Manager (CM) will support the Chief Compliance Officer in maintaining an effective Compliance Program, within the Compliance and Quality Department, to ensure that services are provided in accordance with all applicable federal and state laws, regulations, and the compliance specific accreditation standards. In this role, the CM will perform a range of duties including evaluating all current and new compliance regulations, reviewing Network company processes and leading training sessions. The CM is responsible for identifying and assessing areas of compliance risks for the business units; setting forth the ethical principles and policies which are the basis of the Compliance Program; and collaborating to effectively incorporate the Compliance Program and to carry out the responsibilities of the position.


 


Responsibilities include, but are not limited to:



  • Assist the Chief Compliance Officer in the development and the implementation of an effective Compliance Program.

  • Design and collaborate in the development and the implementation of the annual Compliance Program plan.

  • Ensure that the Compliance Program effectively supports business units with the prevention, detection, and correction of violation of applicable federal and state law, regulations, organization standards of conduct and policies and procedures.

  • Regularly review the Compliance Program and recommend appropriate revisions and modifications, including advising administrative leadership of potential compliance risk areas.

  • Develop and implement Compliance Program standards of conduct and policies and procedures. Assist in the review of businesses units’ policies and procedures.

  • Develop and coordinate appropriate compliance training and education programs, including onboarding training, for all employees.

  • Assess the need for additional training and education.

  • Respond to alleged violations of applicable federal and state laws, regulations, standards of conduct, policies, and procedures, by evaluating or recommending the initiation of fact-finding procedures. Develop and oversee a system for uniform handling of such violations.

  • Develop and implement general risk assessments and corresponding compliance specific monitoring/auditing plans.

  • Implement and operate non-retaliation reporting channels, including an anonymous reporting system available to all employees, volunteers, and business partners.

  • Oversee follow-up and, as applicable, resolution to fact-finding procedures and other issues detected by, or reported to, the Compliance Program, including development of corrective action plans, as needed.

  • Present periodic and annual reports on the Compliance Program to the Chief Compliance Officer.

  • Assist the business units’ leaders in providing adequate information to staff that will ensure that they have the necessary information and knowledge on regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner.

  • Keep abreast of applicable rules and regulations, and standards for accreditation changing within the healthcare and pharmacy industries and update the education program as applicable.

  • Supervise Compliance Analysts.

  • Collaborate with the quality and privacy team, as needed to meet department goals, and perform other duties as assigned.


Required Qualifications :

Experience:



  • A minimum of five (5) years’ supervision experience.

  • A minimum of two (2) years with healthcare law and knowledge of fraud, waste and abuse and Medicare/Medicaid.

  • A minimum of three (3) years’ experience as a compliance officer, compliance manager, or similar position.

  • A minimum of three (3) years conducting monitoring/audits and investigations and/or data analysis.

  • Strong knowledge of pharmacy, managed care, or similar healthcare industry processes and regulations


TechnicalSkills:



  • Knowledge of Microsoft Office programs(Word,Excel,PowerPoint )is required


Languages:



  • Fully bilingual (English and Spanish)


Education:



  • Bachelor's Degree required in law, business administration, health science, or related field.

  • CHC Certification is required upon hire or be obtained within the first twelve (12) to eighteen (18) months of commencing.






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