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Director, Compliance and Quality Oversight - Portland, United States - Health Share of Oregon
Description
Career Opportunities:
Director, Compliance and Quality Oversight
Requisition ID
24168
Health Share of Oregon
Full Time - Permanent
Portland
Multi Location (2)
Job Title
Director, Compliance and Quality Oversight
Exemption Status
Exempt
Department
Delegation and Quality Oversight
Manager Title
Chief Operations Officer
Direct Reports
DQO Manager, Contract Administrator
Requisition #
24168
Pay and Benefits
Estimated hiring range $135,198 - $165,242 / year, 5% bonus target, full benefits.
Posting Notes
This positon is a hybrid role, predominately remote with occastion in-person meetings at the HealthShare of Oregon office.
Job Summary
The Director of Compliance, Delegation and Quality Oversight oversees all compliance, delegation and quality oversight activities of the company to ensure Health Share and delegated entities are compliant with federal and state regulations and contractual obligations related to the Oregon Health Plan Medicaid program.
The position oversees the development, execution, and oversight of all Health Share contracts with particular emphasis on the contract with the Oregon Health Authority and delegation agreements with Health Share subcontractors.
This position serves as the Compliance Officer for Health Share.Essential Responsibilities
Compliance
Develop, execute and oversee a compliance plan which includes risk assessment and monitoring of internal activities related to execution of the Health Plan Services Contract with the Oregon Health Authority.
Identify and evaluate risk factors relative to Health Share's compliance and program integrity obligations; identify potential areas of compliance vulnerability and ensure corrective action to reduce or mitigate these risks.
Develop, implement and oversee program integrity functions, including prevention and detection of fraud, waste and abuse; respond promptly to potential instances of fraud or abuse, reporting to appropriate state and federal agencies.
Effectively collaborate with the Privacy and Security Officer on compliance related issues.
Delegation and Quality Oversight
Lead quality assurance strategies and planning; oversee implementation and effectiveness.
Participate in the development and oversight of cross-functional initiatives with accountability for components related to quality of care, grievance system, and program integrity.
Provide oversight and direct staff in implementing processes for delegation and quality oversight including care and utilization management, quality assurance, performance improvement, and program integrity.
Perform work in alignment with the organization's mission, vision, and values.
Support the organization's commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals.
Adhere to the organization's policies, procedures, and other relevant compliance needs.
Perform other duties as needed.
Knowledge, Skills and Abilities Required
Knowledge:
Advanced knowledge of Federal and State regulations related to Medicaid and ability to interpret and communicate these requirements
Advanced knowledge of principles, practices, procedures and professional standards associated with compliance and quality assurance program management and techniques for evaluation of program effectiveness
Extensive knowledge of managed care and the Oregon Health Plan
Ability to obtain and retain knowledge of
government regulations as they relate to the administration of OHP and Medicare
the principles and practices of coordinated care
health plan benefits, systems and procedures, changes in guidelines and regulations, changes in the health care services, changes in the legal/legislative arena that impact operations
health care public policy issues
Core Skills and Abilities:
Ability to provide effective leadership and direction of staff and delegate appropriate activities
Budget management skills, as well as ability to monitor and address cost effectiveness
Excellent verbal and written communication skills, including the ability to persuade, influence, negotiate and make formal presentations
Ability to analyze and solve problems, prioritize, organize and manage multiple tasks
Adept at utilizing various approaches to achieve consensus, achieve favorable outcomes, manage change and influence others
Ability to work effectively with diverse internal and external stakeholders
Ability to oversee or manage multiple complex projects concurrently, ensuring effective use of resources and achievement of outcomes
Physical Skills and Abilities:
Ability to perform repetitive finger, wrist, shoulder, or neck movement for at least 8 hours/day
Ability to see, read, hear, and speak clearly for at least 8 hours/day
Cognitive Skills and Abilities:
Ability to focus on and comprehend information and learn new skills and abilities
Ability to assess a situation and seek or determine appropriate resolution
Ability to accept direction and feedback, as well as tolerate and manage stress
Education and/or Experience
Required:
Minimum 8 years' experience in related work, including 4 years' experience in Medicaid/Medicare compliance and quality assurance experience
Minimum 4 years' experience in a supervisory position
Preferred:
Compliance and quality assurance experience in a managed care setting
Working Conditions
Primary Work Environment:
Indoor/Office
Member Facing
Patient Facing
Facilities/Security
Other Work Environment(s):
Indoor/Office
Member Facing
Patient Facing
Facilities/Security
Outdoor Exposure
Hazards:
n/a
Equipment:
General office equipment
Travel:
This position may include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.
Health Share is an equal opportunity employer and employs personnel without regard to age, citizenship, color, creed, physical or mental disability, economic status, education, ethnicity, family responsibilities, gender identity and expression, genetic information, health status including HIV status, height, housing status, marital status, matriculation, national origin, physical appearance, race, religion, political affiliation, pregnancy, sex, sexual orientation, union membership, veteran status or other unlawful factors, with respect to recruiting, hiring, job assignment, promotion, discipline, discharge, compensation, training and other terms, conditions and privileges of employment and contracting.
Health Share is committed to creating a diverse staff made of people who are dedicated, optimistic and committed to health equity from all segments of the greater Portland Region, and we encourage people of color, people with disabilities, LGBTQ+ people, women and nonbinary people, and Veterans to apply for consideration.
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