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Compliance, Privacy & Regulatory

Putting Integrity Into Practice

Promoting honesty and integrity across our daily actions and interactions, our compliance, privacy, and regulatory professionals provide the guidance and resources to uphold the highest ethical standards.

Regional Compliance Officer - GA

Location: Georgia, GA Job Number: 676396 Date posted: 02/21/2018
Description: Reporting directly to the National VP Enterprise Regional Compliance & Georgia Regional President, the Exec Dir, Regional Compliance, is responsible for the development, implementation and on-going refinement of strategies for an effective compliance, ethics and integrity and privacy/security program. They ensure an effective compliance program including education and monitoring for the region. They lead regional efforts to ensure compliance with the Medicare Part D and other Government Program requirements. They provide leadership and oversight of compliance audits, investigations (including Fraud, Waste & Abuse prevention [FW&A]), and corrective actions plans. They direct compliance functions, including Privacy and Security Compliance at the regional level. Depending on region, they provide leadership and supervision in collaboration with Area/Regionalized leadership for the direction of Hospital Medical Center Compliance Officers. They function as an integral member of the senior leadership team in the region; working in close collaboration with the Permanente Medical Group leadership to effect medical group compliance program. They lead the Regional Executive Compliance Committee. Authority includes ability to report directly to the KFHP/H Boards of Directors; interview employees and relevant individuals; review and retain company contracts pertinent to the Medicare Part D and other Government programs; seek advice from legal counsel; report misconduct to CMS, other government agencies or law enforcement; conduct and direct internal audits and investigations of any entities.

Essential Functions:
  • Develop, implement and maintain comprehensive compliance program for the Region, build on existing activities to enhance the infrastructure; partner with operations in the continued development of tools that facilitate ongoing implementation of compliance requirements to include procedure templates, self-monitoring tools, manuals, systematic control reviews and report formats.
  • Medicare Part D - responsibilities include but are not limited to: develop and monitor implementation and compliance with Part D related policies and procedures through the creation and implementation of workplans; reports at least quarterly to the CCO/BOD/CEO on the status of the implementation and ongoing monitoring of the compliance program; identifies and resolves potential or actual instances of non-compliance and on other audit activities.
  • Working closely with NCO, ensure that first tier, downstream and related entities, particularly those involved in sales and marketing activities, are aware of and follow the requirements for Medicare Part D and other sales and marketing activities.
  • Ensure that the regional compliance program meets regulatory requirements and NCO standards while enhancing organizational performance.
  • Lead regional ethics and integrity initiatives and provide strategic direction on Regional initiatives, (POR/COI etc); assumes dissemination and awareness of POR.
  • Oversee the development of the region-s compliance policies and procedures; assures policies accurately and effectively communicate legal, regulatory and accreditation requirements, and meet internal policies and procedures and ethical standards; periodically reviews and initiates needed updates
  • Collaborate with the National Compliance Office on program wide compliance initiatives.
  • Lead the Regional Compliance Committee; meet at least quarterly; develop strategies to promote compliance; ensure training; assist in CAP activities; develop and implement corrective and preventive actions; oversee internal controls; ensure current policies; ensure retaliation free process for reporting.
  • Oversee the development and implementation of appropriate education and training programs to ensure employees, physicians (where appropriate and/or working in partnership with Permanente Compliance Officer) and management are knowledgeable about their compliance responsibilities and Ethics Programs and, where appropriate, provide the same for all employees with Part D program responsibilities including written standards and the applicable statutory, regulatory and other requirements. Regularly update Executive Compliance Committee and all governing bodies on training status.
  • Oversee and support the development of compliance risk mitigation and corrective action plans
  • Working closely with Human Resources departments, ensure the DHHS OIG and GSA exclusion lists have been checked with respect to all employees, officers, directors, and managers as well as assuring first tier, downstream and related entities are not included on such lists
  • Provide timely reports on compliance issues to regional leadership and NCO.
    Supervise sensitive compliance investigations and ensure the integrity of the process
  • Oversee the development and implementation of the regional anti-fraud program including the coordination of internal investigations and development of appropriate corrective or disciplinary actions with NCO. Develop and implement methods and programs that encourage managers and employees to report suspected fraud and other misconduct without fear of retaliation; ensure proper reporting of violation or potential violations including potential fraud or misconduct to duly authorized enforcement agencies as appropriate and/or required
  • Work closely with Internal Audit and NCO-NSIU whenever applicable; where/when applicable and appropriate, coordinate with Medicare Fraud Control Units (MCFUs), commercial payers, and other organizations when a FW&A issue is discovered to involve multiple parties.
  • Oversee and ensure the integrity of the regional hotline process
  • Ensure that shared service and/or nationally managed functions meet regional compliance accountabilities when serving the region.
  • Hire, develop and manage compliance/ethics and integrity and privacy staff

  • Basic Qualifications:
  • Minimum ten (10) years of escalating managerial work-experience in a highly diversified organization
  • Minimum ten (10) years of escalating responsibility and work-experience in compliance field (internal audit, law, etc); to include progressive management roles in large, complex organization with successive levels of accountability and results.
  • Bachelor-s degree in related field (Health Care, Business, etc)
    License, Certification, Registration
  • N/A.

    Additional Requirements:
  • Significant compliance orientation, coupled with business process expertise and acumen.
  • Demonstrated knowledge of current thinking and practice around the business of compliance.
  • Significant knowledge of all pertinent regulatory requirements and compliance program elements
  • Demonstrated ability to collaborate, communicate and work effectively with senior leadership and a broad cross section of management/leadership from a broad range of functional areas.
  • Demonstrated ability to influence and motivate interdisciplinary teams and individuals who do not report directly to the CCO.
  • Demonstrated expertise in organizational development, project management, and strategic planning
  • Superior communications skills (both oral and written)
  • Demonstrated high ethics and integrity
  • This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanente-s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and Kaiser Permanente-s policies and procedures.

    Preferred Qualifications:
  • Masters preferred.
  • KP experience preferred

    Primary Location: Georgia,Georgia,Unknown Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon-Fri Working Hours Start: 8:00 am Working Hours End: 5:00 pm Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Director/Senior Director Job Category: Compliance / Privacy / Regulatory Department: National Compliance Office Travel: Yes, 10 % of the Time
    Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
  • About Compliance, Privacy & Regulatory Careers

    Compliance, Privacy & Regulatory Careers

    We've established a comprehensive, world-class compliance, privacy, and regulatory program, giving you the chance to make a difference in the lives of millions. As a member of this team, you'll engage with internal stakeholders to foster an environment of safety and trust for our members, physicians, and employees alike.

    Helping to establish and maintain an effective compliance program, you'll ensure that we operate according to the highest ethical standards and follow all applicable laws, standards, policies, and procedures. Everything we do — from developing policies and training to protecting privacy and security — reinforces our commitment to our members, regulators, and the communities we serve.

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