Director of Compliance

Description

AllMed Healthcare Management’s mission is to improve the quality and integrity of healthcare by providing independent medical review services that help payers and providers deliver better health outcomes. We partner with hundreds of leading health insurance and hospital organizations and have maintained consistent growth, through our commitment to the highest quality, client satisfaction, and technology innovation. Services are delivered through PeerPoint®, AllMed’s state-of-the-art medical review portal. We have recently undergone a Lean transformation in our Clinical Operations, with the goal of driving continuous improvement in our performance.

The Director of Corporate Compliance is a strategic leadership role responsible for overseeing and implementing comprehensive Compliance programs for AllMed Healthcare Management, Inc.

The Director of Corporate Compliance duties include responsibility for developing and maintaining an effective Corporate Compliance and Quality Program. Including best practices for risk assessment, monitoring and reporting, internal policies and procedures, training and education, conducting client audits, supporting regulatory and audit inquiries, keep up to date on state and federal regulatory changes and ensuring AllMed stays compliant with federal and state regulatory controls for HITRUST, HIPAA, URAC and NCQA accreditation standards.

Expectation:

Maintain and develop a Corporate compliance program that meets the needs of clients and regulatory bodies.

Reporting:

Reports to the CEO and works closely with all AllMed staff.

Essential Duties and Responsibilities:

• Manage HITRUST, URAC and NCQA certification processes including updating or drafting new policies and procedures, supported by any necessary auditing to ensure adherence to defined policies and procedures.
• Develop and maintain a robust quality system to monitor overall effectiveness of policies, procedures, and training.
• Develop a robust corrective action process to support continuous improvement and compliance efforts resulting from any of the following: Client Audits, Vendor Audits, Client Reporting, Identified Data Breaches or Employee Reporting.
• Review policies and procedures related to HIPAA Security Rule physical, administrative and technical safeguards.
• Address issues related to access controls, business continuity, disaster recovery, and incident response. This includes updating documentation and auditing of these processes/systems.
• Communicates directly with clients as needed to support business needs and develop relationships with key stakeholders. This will include activities related to audits, business review meetings, new business and IT security questionnaires. Oversee the peer credentialing and vendor onboarding processes to ensure regulatory compliance.
• Provide strategic direction and leadership over the compliance including oversight and support to ensure integration into business operations and work with key stakeholders to ensure organization initiatives are implemented.
• Implements compliance monitoring activities along with measurement and reporting and developing policies and procedures that are compliant with state federal and accrediting requirements.
• Establishes and maintains dialogue with regulatory agencies, the executive team and other stakeholders to effectively communicate compliance program developments.

Expectation: Continuous improvements are made to enhance compliance and IT security posture.

Expectation: Successfully complete audits for regulators and AllMed’s clients.

Expectation: AllMed & staff are up to date with all policies and procedures regarding regulatory requirements of HITRUST, URAC and NCQA accreditations.

Other Responsibilities:

1. Report on Compliance as requested at management and staff meetings.
2. Maintain effective rapport with other staff members, client professional support staff, administrators, and physicians’ offices.
3. Actively support corporate strategic plans. Participate in strategic planning as requested.
4. Maintain confidentiality and privacy as defined by state, federal, and company regulations and policies.

Qualifications:

• Experience with regulatory compliance requirements pertaining to Healthcare Operations, particularly Utilization Management and Independent Review.
• Experience establishing and communicating compliance procedures and policies.
• Experience navigating an organization through external audits.
• Experience establishing and developing an annual compliance plan, including compliance training and oversight activities.
• Experience managing and conducting annual and periodic compliance assessments and guiding the implementation of post-audit and monitoring recommendations.
• Demonstrated strategy for analyzing and preventing security incidents in highly complex environments.
• Demonstrated knowledge of HITRUST and HIPAA compliance and in-depth knowledge of the industry’s standards and regulations.
• Methodical and diligent with outstanding planning abilities; ability to manage and prioritize multiple projects.
• Excellent analytical and problem-solving skills.
• Strong relationship building and communication skills.

Education and/or Experience:

1. 5 years or more of Healthcare Compliance experience.
2. Ideally experience across multiple credentialing entities.
3. Strong communication and collaboration skills.
4. Lean methodology experience or training.
5. Must be able to work in a fast-paced environment.
6. Minimum of Bachelor’s degree, but Master’s degree preferred.

Benefits

AllMed’s offers a competitive compensation and benefits program includes comprehensive medical and dental care, matching 401(k), paid time off, flexible spending accounts, disability coverage, and other benefits that help provide financial protection for you and your family.

AllMed provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, AllMed complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities.

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