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.
Executive Director , Medicaid ComplianceLocation: Oakland, CA Additional Locations:
Job Number: 782442 Date posted: 03/15/2019
This position serves as the compliance leader for NCO strategy development and ongoing management of a Program-wide Medicaid Compliance Program. This program includes but is not limited to oversight, training, monitoring and assessments of compliance risks associated with Kaiser Permanente's Medicaid contractual arrangements, and federal and state Medicaid rules. This positions partners with national and regional business leaders to coordinate the successful execution of strategic Medicaid compliance initiatives, metrics and compliance controls. This position also: Facilitates effective decision making on applicable business decisions with compliance implications at the executive level. Implements a system of compliance management information to inform risk mitigation activities and decisions related to Medicaid compliance. Provides consultation to the Medicaid line of business and executive leadership on Medicaid compliance requirements. Develops and delivers NCO's work plan as pertains to Medicaid compliance, which includes Program wide risk assessment, monitoring, and risk mitigation and remediation of Medicaid compliance issues.
- As stated above in summary form, this leader is responsible for:
- Medicaid Contract Compliance: For CA, directly support Medicaid compliance activities in collaboration with HPRS and the regional Medicaid line of business. For regions outside of CA, partner and collaborate with regional compliance office staff to assure that contractual requirements with compliance implications are identified and assessed from a risk perspective on an ongoing basis.
- Implementation and maintenance of the Medicaid compliance program including regular reports on status and actual or potential instances of non-compliance; monitors implementation of appropriate corrective; supports reports of suspected fraud and/or operational non-compliance and provides meaningful tracking and reporting mechanisms.
- Development of compliance strategy, work plans and monitoring tools related to Medicaid Compliance Program in collaboration with national and regional compliance offices to create sustainable processes.
- Interpretation of federal Medicaid compliance requirements and oversight of operational requirements which represent significant risk to the Program.
- Advises Vice President of Health Plan Compliance of areas of high risk/vulnerability and directs or participates in the mitigation strategies to address risks.
- Assist oversight bodies that support compliance programs, such as the NHPCC, and the Medicaid line of business community of practice developed to support Medicaid programs Program-wide.
- Representing the Program on issues related to compliance with federal Medicaid requirements, working with the SVP of Medicaid Line of Business and senior leaders where appropriate.
- Incorporate the Medicaid fraud control and program integrity reporting and data mining efforts into the national oversight functions.
- Minimum ten (10) years professional experience in health care leadership, with compliance leadership experience preferred, including extensive understanding of health plan operations required.
- Minimum five (5) years of experience with Medicaid programs, with focus on legal, compliance or operational functions which includes five (5) years working with Federal Regulatory issues, interpreting statutes and regulations and working in a regulatory environment.
- BA degree required.
License, Certification, Registration
- Direct experience with Program Integrity standards and reporting.
- Outstanding written and oral communication skills required.
- Experience with business process improvement to impact compliance and the tools and data requirements for supporting an effective business process improvement project to impact compliance. Demonstrated ability to conduct and interpret quantitative/qualitative analysis relative to compliance and/or other related organizational objectives.
- Advanced degree preferred
- Demonstrated ability to determine key business issues and develop appropriate action plans from multidisciplinary perspectives.
- Proven leadership skills in project management. Must exhibit efficiency, collaboration, candor, openness, and results orientation. Ability to exercise good judgment and political astuteness.
- Superior communication, consulting, facilitation, negotiation, conflict management, problem resolution, change management skills and consensus building skills.
- Ability to adapt to constantly changing priorities in managing a wide range of projects.
- Demonstrated ability to structure, drive and execute complex multi-disciplinary issues with intangible benefits to closure.
- Proven ability to effectively manage in ambiguous situations.
- Proficient in team building, conflict resolution, group interaction, project management, and budget management.
- Demonstrated ability to lead professionals and manage others through influence and collaboration.
- Demonstrated understanding of the compliance issues related to operations and/or business of KP, health policy trends, and any applicable external requirements (statutes, regulations or accreditation standards) related to relevant issues. Familiarity with Kaiser Permanente organization and operations for applicable area and personnel highly desired.
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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