Director, Compliance And Quality Oversight (24168)

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. www.careoregon.org/about-us/careers/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.

• Identify and evaluate potential risk factors in delegating regulated functions; 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.

• Develop and implement company training and education program related to program integrity and compliance.

• 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.

• Develop, update and revise policies and procedures related to areas of accountability.

• 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.

Organizational Responsibilities

• 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.

• Strive to meet annual business goals in support the organization's strategic goals.

• 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.

#Li-Hybrid

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.

Visa sponsorship is not available at this time.