Director of Federal and Integrated Product Compliance

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Director of Federal and Integrated Product Compliance, reporting to the Vice President of Compliance, plays an integral role in the oversight and management of product regulatory compliance activities for federal and integrated products offered by MetroPlusHealth including Medicare, MAP, MLTC and IB Duals. Overseeing a team of product compliance specialists, this role is responsible for monitoring all related regulatory guidance and implementations for compliance, supporting the organization with corrective actions and regulatory disclosures, and contributing to the annual compliance risk analysis and work plan.

• Oversees a team of product regulatory compliance specialists for Federal and integrated products offered by MetroPlusHealth.
• Contributes to the annual Plan risk assessment, collaborating with the various Compliance teams, to assist the enterprise in identifying areas with potential compliance issues.
• Supports the completion and presentation of the Annual Compliance Work Plan and oversees completion of auditing and monitoring projects assigned to the Federal and Integrated Product Compliance Department.
• Develops, implements and revises policies and procedures for the Regulatory Compliance Department.
• Responsible for the day-to-day operations of the Federal and Integrated Product Compliance Unit.Prepares and updates materials for compliance committees including the Vendor
• Delegation Oversight Subcommittee, Compliance Committee, and Audit and Compliance Committee of the Board of Directors.
• Provides implementation oversight by ensuring regulatory requirements have been effectively implemented by the internal and external business areas for Medicare, MAP, MLTC and IB Duals.
• Ensures open lines of communication, both internally and externally, so any reports of potential non-compliance are received and investigated.
• Assists in the identification and resolution of noncompliance issues. Upon identification, provides support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance review. If self-disclosure is required, compiles and prepares necessary information.
• Assists business areas in creating and updating monitoring metrics to assess continued compliance with regulatory requirements.
• Manages annual external audit of the Compliance Program as required by regulation, to include evaluation of both the Medicare and MAP Compliance Plans and collaboration with Corporate Compliance for evaluation of fraud, waste, abuse, privacy and record retention functions.
• Serves as a voting member of the Vendor Delegation Oversight Subcommittee; providing Compliance advisement and ensuring all delegate related non-compliance issues/trends are reported. Participates in auditing and monitoring functions of downstream entities.
• Other duties as assigned or requested.
  

• Bachelor's Degree required, Masters Degree in Health Care or JD preferred.
• Minimum 7 years' experience in managed care operations, health care administration or quality improvement with direct oversight and leadership experience in auditing, delegation oversight, regulatory requirements specifically CMS and NYS DOH.
• Proven leadership as evidenced by 3-5 years' experience in leading and directing teams with divergent experience and goals from different departments, including managing multiple projects with various priorities and deadlines.
• Ability to use software to produce required documentation and reports.

Licensure and/or Certification Preferred

• CHC, CCEP Preferred

Professional Competencies

• Integrity and Trust
• Customer Focus
• Outstanding interpersonal and human relations skills; ability to organize and lead work teams, establish and maintain strong positive working relationships.
• Strong problem solving, analytical, negotiating, and independent decision-making skills paired with strong attention to detail.
• Ability to make independent decisions with Plan department leaders, external vendors, regulators, and accreditation bodies.
• Exceptional and creative troubleshooting skills with a keen ability to expediently analyze situations and implement process improvements and effective solutions.
• Proficient in understanding and speaking the English language, with strong written communication verbal in person and telephonically and presentation skills.
• Demonstrates ability to manage conflict, build, support, mentor teams and the ability to recognize and address positive behaviors that contribute to successful achievement of Plan goals.

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