Director, Compliance (Nevada Health Plan) - Remote in Nevada

Molina Healthcare•Long Beach, CA

2d•Remote

About The Position

Leads and directs team responsible for compliance activities. Seeks to ensure the organization adheres to regulatory requirements, industry standards, and Molina internal policies, and prevents and/or detects violation of applicable laws and regulations, and protect the business from liability, fraudulent or abusive practices.

Requirements

At least 8 years of experience in compliance, risk management, and/or auditing, or equivalent combination of relevant education and experience.
At least 3 years management/leadership experience.
Extensive knowledge of relevant regulatory frameworks and industry standards.
Experience developing and implementing compliance programs and controls.
Strong leadership, strategic thinking, and decision-making capabilities.
Ability to thrive in a cross-functional highly matrixed environment.
Strong analytical and problem-solving skills.
Project management experience.
Ability to build rapport and gain the respect and collaboration of internal/external stakeholders.
Knowledge and ability to think creatively, proactively, and independently.
Ability to prepare reports and presentations and manage data.
Self-motivated and results oriented.
Strong organizational skills and the ability to meet delivery targets.
Disciplined and ability to effectively track, document and report on projects/activities.
Strong verbal and written communication skills.
Microsoft Office suite and applicable software program(s) proficiency.

Nice To Haves

Previous experience in a health plan or government programs setting (Medicaid, Medicare, Marketplace).
Certificate in Healthcare Compliance (CHC), or other compliance-related certification.

Responsibilities

Directs and oversees compliance activities and serves as a resource on compliance issues.
Demonstrates leadership and expertise to ensure compliance with applicable state/federal statutes and internal policies.
Facilitates training and education, and subject matter expertise related to compliance requirements.
Ensures business accountability for compliance investigations - ensuring oversight, follow-up, and resolution.
Enforces the compliance plan, code of conduct and anti-fraud plan.
In conjunction with compliance leadership and the special investigative unit (SIU) team, develops an active relationship with third parties who have specific experience in conducting fraud, waste and abuse (FWA) investigations.
Prepares written quarterly reports to inform compliance leadership on the status of activities pertaining to overall compliance for area(s) of responsibility.
Oversees team of compliance professionals; responsible for hiring, performance management, recognition, and staff development.