Manager Compliance

Profile

Manager Compliance

Responsibilities:: Responsible for the development, implementation and maintenance of an effective compliance program in accordance with state and federal statutory and regulatory requirements and Sharp Health Plan policies and procedures. Responsible for providing effective leadership for Sharp Health Plan in the areas of: commercial and government program health plan compliance; privacy; fraud, waste and abuse; government contract compliance; and delegation oversight. Responsible for plan-wide audit activities, including audits of Sharp Health Plan’s internal business units and first tier, downstream and related entities (FDRs). Directs follow-up assessment of newly implemented legislative and regulatory requirements to ensure compliance. Participates in the development of risk assessment tools and in conducting risk assessments for business units and FDRs, and develops a comprehensive audit plan tailored to address the relative risks presented by each business unit and FDR. Develops and maintains compliance-training programs. Develops and maintains subject matter expertise on legislative, regulatory and contractual issues affecting commercial and Medicare health plans in California. Monitors industry best practices and makes recommendations for organizational policy and procedure change that will result in compliance. Cultivates positive relationships with regulators, including, the Center for Medicare & Medicaid Services (CMS) and the California Department of Managed Health Care (DMHC). Interacts effectively with various internal and external departments and leaders to provide guidance, information and assistance. Reports on compliance activities to the Director of Compliance and Regulatory Affairs and the Chief Compliance Officer. Promotes the satisfaction, development and productivity of department staff. Participates as a part of, and in support of, a management team that works collaboratively to ensure the success of Sharp Health Plan’s goals, objectives, and strategic initiatives.

Company info

Sharp Healthcare
3131 Berger Avenue Suite One
San Diego
California
United States 92123
Website : http://www.sharp.com