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Vice President , Regional Compliance Officer - SCAL RegionLocation: Pasadena, CA Additional Locations:
Job Number: 824914 Date posted: 08/21/2019
The Regional Compliance Officer is responsible for overseeing and managing the effective implementation of the KFHP/H Ethics and Compliance Program in the region. This includes management of the regional compliance team, as well as the compliance personnel supporting the service areas and medical centers located in the region. Working in close collaboration with the Chief Compliance Officer and the national compliance leaders, the Regional Compliance Officer provides executive level leadership to the Regional President and regional leadership team, promoting a culture of integrity and acting as an independent and objective professional on all ethics and compliance matters and initiatives in the region. The Regional Compliance Officer creates and supports region-wide activities designed to achieve the highest level of business ethics and compliance with internal policies, contractual requirements, and applicable federal and state laws affecting health care providers and health plans, including those related to government programs (e.g., Medicare, Medi-Cal). This position is a member of the regional leadership team and also requires a strong working relationship with the Southern California Permanente Medical Group leadership.
- Implements the KFHP/H Ethics and Compliance Program in the region, as described in the Ethics and Compliance Program Charter.
- Accomplished leader in developing large teams and mentoring others, as well as successfully developing diverse, high-performance teams in highly complex environments
- Participate as a member of the National Compliance Leadership Team in the development, implementation, monitoring and completion of the compliance strategic plan
- Provide strategic leadership and guidance to executive/senior leadership related to the implementation and management of the compliance program in a large region / function or group of regions and functions of 74,500+ employees
- Monitors industry compliance trends and develops and leads systems and structures designed to analyze compliance risk areas and develops strategies to mitigate those risks. Compliance risks include but may not be limited to: fraud, waste and abuse; privacy and security of protected health information; member and patient rights; regulatory requirements impacting care delivery and the operation of health plan products, particularly government programs; documentation, coding, charging and billing; and adherence to the organization-s code of conduct, The Principles of Responsibility.
- Collaborates with key stakeholders in support of region-wide evaluations. Creates and manages a consultative partner model for regional compliance staff to provide support, assessment, and guidance to key stakeholders. Evaluates and reports effectiveness of the regional compliance program to the Regional President, regional executives, and the Chief Compliance Officer.
- Ensures compliance-related audits performed by internal and external entities are effectively managed and that corrective action plans are implemented and sustained. Ensures Regional President, executives, and NCO are informed of audits and results.
- Ensures the annual assessment, review, and (as appropriate) drafting of regional policies and procedures that support compliance with applicable regulations and KFH/HP policy positions.
- In collaboration with the national compliance training team, ensures regional staff receive general ethics and compliance training for all new KFH/HP employees and, as appropriate, directors, contractors, and agents within the first 30 days of employment/engagement, and general refresher training each year thereafter. Ensures job-specific training is provided to those employees who work in areas that pose higher compliance risk that are deemed to require specialized compliance training.
- Institutes and maintains an effective compliance communication program to promote the use of the compliance hotline; heightened awareness of the code of conduct, The Principles of Responsibility, and understanding of new and existing compliance issues and related policies and procedures.
- Monitors compliance activities of operational and administrative departments; remains informed, identifies trends, and advocates at the executive level for necessary improvements. Establishes and maintains a timely and relevant compliance monitoring plan; ensures metrics provide performance measures and indicate general levels of compliance program effectiveness.
- In collaboration with national compliance leaders, leads the investigation of reports of suspected misconduct and alleged violations of rules, regulations, policies, procedures, and standards of conduct. As appropriate, works closely with internal and external legal counsel to address instances of non-compliance that require legal guidance. When appropriate, exercises authority to curtail or stop practices that do not appropriately align with compliance requirements.
- Provides significant support and collaborates with the Southern California Permanente Medical Group to ensure investigation of compliance issues involving non-physician employees, as well as general support for compliance initiatives across our integrated delivery system (e.g., compliance training).
- Chairs the Regional Compliance Committee composed of the Regional President, the Regional CFO, and other appropriate senior level executives from the region (e.g., Legal, Quality, Human Resources), convening no less than quarterly every calendar year.
- In collaboration with the national compliance team, oversees the development and implementation of the regional anti-fraud program including the coordination of internal investigations and development of appropriate corrective or disciplinary actions. Develops and implements methods and programs that encourage managers and employees to report suspected fraud and other misconduct without fear of retaliation; ensures proper reporting of violations or potential violations including potential fraud or misconduct to duly authorized enforcement agencies as appropriate and/or required.
- Prepares routine reports regarding high priority compliance issues for the Regional President, the regional compliance committee, and the SVP/Chief Compliance Officer.
- 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 a compliance-related field (internal audit, law, etc); to include progressive management roles in large, complex organizations with successive levels of accountability and results.
- Bachelor-s degree in related field (Health Care, Business, etc.).
License, Certification, Registration
- Significant compliance orientation, coupled with business process expertise and acumen.
- Demonstrated knowledge of current thinking and practice around the business of compliance.
- 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 role.
- Demonstrated expertise in organizational development, project management, and strategic planning.
- Excellent writing, public speaking, and project management skills.
- Ability to understand and synthesize complex areas of law and government policy, and communicate effectively with executives, managers, and staff.
- High level of personal and professional integrity.
- Masters preferred.
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.
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