The Senior Director Regulatory Compliance - Government Programs leads a team that is accountable for monitoring regulatory requirements affecting CareCentrix government program operations, analyzing and documenting those requirements, communicating and educating affected business areas about those requirements, developing training programs to ensure an understanding of those requirements, and working with affected business areas to modify operations and policies and procedures to ensure compliance.
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Lead a team responsible for monitoring federal and state laws impacting CareCentrix’s government program operations, analyzing the information, and preparing and circulating written communications to affected business areas regarding such laws.
• Provide support, guidance and direction in the development of policies, procedures, and other operational changes necessary to comply with legal requirements and support the operational areas in the implementation of such policies, procedures, and other changes as required.
• Create and implement compliance tracking, trending, and reporting tools.
• Partner with internal compliance and legal resources for interpretive guidance, working closely with the Chief Compliance Officer, Senior Directors, Directors and Analysts to ensure accuracy of interpretation of legislation and regulations.
• Perform internal audits and identify opportunities for improvement.
• Develop and deliver training programs to ensure a clear understanding of compliance requirements.
• Assist Chief Compliance Officer in other matters as needed.
• Adhere to and participate in the Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices.
• Review and adhere to all Company policies and procedures.
Bachelor’s Degree required. Juris Doctorate or Masters Degree preferred. Minimum of 12 years’ experience in a managed care setting. Must have excellent interpersonal skills, thorough understanding of federal and state laws impacting health insurers and their delegated entities, including but not limited to, laws impacting utilization management, claims, and credentialing for governmental health plans (Medicare, Medicaid). Competent in the use of computers, data display, PowerPoint, SharePoint, and Excel. Excellent legal research skills, attention to detail, and oral and written communication skills. Managerial experience preferred.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.