AmeriHealth Caritas Director Compliance in New Castle, Delaware

Director Compliance


Description

AmeriHealth Caritas Delaware is excited to have been chosen as one of the Medicaid managed care plans for the Diamond State Health Plan and Diamond State Health Plan- Plus programs. Backed by a national organization, we have long-term experience serving the Medicaid population in neighboring states. We are committed to delivering health care through innovative services and programs and are looking forward to helping Delaware become an even healthier stat.

Responsibilities:

Under the direction of the Vice President, Corporate Compliance, the Director, Compliance provides strategic direction and leadership for the development and implementation of compliance policy, process and control activities and provides oversight of all operating division and subsidiary compliance, privacy, and regulatory functions, in addition to possessing the following attributes:

  • Demonstrates a solid understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines.
  • Develops compliance methodologies to test established and newly executed operational processes and controls and monitor effectiveness.
  • Proactively identify process gaps, weaknesses and deficiencies and/or business productivity/efficiency opportunities.
  • Partners with local and corporate counterparts to develop protocols that support the review and assessment of objectives that ensure compliance with local plan and corporate policies and procedures.
  • Develops and monitors metrics and ensures accurate reporting of regional/local compliance information and compliance and FWA issues reported via the compliance hotline.
  • Ensure that local compliance related issues and risks are identified, aggregated and reported.
  • Directs ad-hoc compliance assessments/research as requested by the local compliance associates.
  • Aligns and monitors compliance training and education programs.
  • Assists in the development and implementation of the annual enterprise compliance plan.

The Director, Compliance may directly manage and support the development of highly skilled and knowledgeable associates. Must be able to operate independently with minimal management oversight and be able to manage competing priorities and deadlines that are subject to frequent change. Must possess and exercise excellent professional judgment in all interactions.

Education/Experience:

  • Bachelor’s Degree or equivalent education and a ten years of experience in managed health care.
  • advanced degree and/or JD preferred.
  • Certified in Health Care Compliance preferred.
  • 5-10 years' in a managed health care environment, including experience in the areas of compliance oversight.
  • Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.
  • Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication)
  • Self-motivated with demonstrated project management skills.
  • Strong oral and written communication skills.
  • Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
  • Strong interpersonal skills.
  • Innovative and creative. Able to embrace change and think outside the box.
  • Strong problem solving and critical thinking skills.
  • Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.
  • Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.
  • Acts independently and requires minimal supervision.