Kaiser Permanente Compliance Program Manager in Santa Clara, California
Working under the direction of the Compliance&Privacy Officer adheres with KP Compliance Framework, fosters comprehensive compliance projects through a series of activities to comply with all applicable regulations and statutes. Provides professional/technical guidance to team member and employees at large and presents complex information throughout the organization. Impacts the achievement of key functional and/or KP objectives that have direct and significant business impact. Contributes to the development of the department's objectives and participates in the development of the annual risk assessments, work and audit plans. Could have a primary functional area of emphasis in one or more of these areas: Investigations, Scope of Practice, Privacy, Health Information Management/Coding, Revenue Cycle, External or Internal Auditing or Statistical Analysis.
Project Planning: Oversees and/or directs teams in identifying accountabilities for local/regional compliance programs & consulting staff. Leads/ manages efforts in developing compliance work & audit plans. Oversees the development & completion of annual risk assessments. Establishes compliance goals, timelines, approaches & strategies in support of organizational initiatives. Establishes & or leads compliance related committees/work groups to cultivate & reinforce appropriate group values, norms & behaviors. Identifies areas of performance improvement & establishes/delegates resources to lead compliance related projects. Oversees & leads on-going efforts to establish, identify&manage internal/external resources & agency relationships.
Investigations: Oversees the administration of investigation processes & activities. Evaluates & performs analyses of investigation activities. Provides guidance & recommendations for next steps. Develops customized investigation activities to address complex, rare or sensitive findings. Leads & manages efforts to identify potential compliance issues & areas of compliance requirements, Establishes & promotes a collaborative environment w/ other functional areas in investigating potential compliance issues. Establishes framework & strategies for developing & creating investigation project plans. As needed for sensitive or political situations, will participate & assist w/ investigation interviews, findings & recommendations. Collaborates w/ clients to determine complex corrective action plans appropriate to substantiated allegations & investigation findings.
Validation: Manages & leads audits on scope of practice, licensing, site of service & other identified areas at risk for compliance violations. Responsible for identifying compliance risks & developing related corrective action plans. Assesses completion rates &operational sustainability. Oversees the administration of compliance programs & content, including design, completion of risk assessments and/or audits, investigations processes&activities, instances of reported non-compliance. Determines impacts of implementation of new regulations & statutes & required notifications, changes, & training. Develops communication strategies to address impacts & required changes. Identifies & delegates resources to support risk assessment & implanting required changes. Researches & stays abreast of regulations & statutes exhibiting extensive knowledge on a wide variety of clinical & non-clinical compliance issues. May engage external regulatory & legislative bodies on developing regulations & laws, providing input & representing Kaiser Permanente's interests.
This job description is not all encompassing.
- Minimum eight (8) years of experience in a health care environment, (managerial or clinical disciplines) with at least five (5) years in healthcare compliance and privacy.
Bachelor's degree in health care administration, business administration, finance, economics, operations research, public health or other health care related field OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- If applicant does not have the CHC, then must complete within 12 calendar months of hire.
Advanced knowledge of compliance principles, theories, and concepts.
Extensive knowledge of health care compliance policies, programs, practices, systems, related compliance issues.
Thorough knowledge of the elements of an effective Ethics and Compliance program and broad knowledge of health care industry practices and standards including both federal, state regulations and accreditation standards.
Excellent Skills in written and verbal communication, meeting facilitation, presentations, analysis, collaboration, project management, decision making, stewardship, negotiation, and leadership.
Strong knowledge of federal and state reimbursement program requirements (e.g. Medicare and Medi-Cal) and privacy and consent laws.
Must be able to work in a Labor/Management Partnership environment.
Focused experience in any of the following areas: Revenue Cycle, Clinical Documentation/Coding, Risk Management, Auditing/Claims Review, Project Management, Defense Auditing.
Master's degree preferred.
Certified in Healthcare Compliance (CHC) or other equivalent compliance certification preferred.
TITLE: Compliance Program Manager
LOCATION: Santa Clara, California
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.