Director, HP Compliance

University of Utah Health•Murray, UT

17h

About The Position

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA This position is responsible for establishing a comprehensive compliance program that is designed to govern the internal programs and policy decisions of the health insurance plans in order to meet the standards set by government laws and regulations. Some of the functions are under the sole direction of the UUHP Compliance Director and others are in collaboration with the Chief Compliance Officer of the University of Utah Health Science System. This position has no responsibility for providing care to patients. Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Requirements

Bachelor's degree in a relevant field or equivalency.
Five years of progressive leadership experience with a track record for results oriented performance.
Five or more years of relevant compliance / regulatory experience.
Strong background in federal ERISA law, related regulations.
Knowledge of and experience with Medicaid, Commercial, and Medicare insurance programs preferred.
Excellent analytical, regulatory interpretation, oral and written communication, and influence skills.
Demonstrated use of sound judgment to assess and prioritize risks and issues carefully.
Ability to master quickly and navigate a complex legal and organization structure.
Ability to work effectively, independently, and as part of a team.
Ability to supervise and communicate effectively with staff, management and executives.
Advanced analytical skills and problem solving skills with the ability to formulate and communicate recommendations for improvement.
Highly effective and experienced written and oral communication skills.
Ability to lead, delegate and effectively manage a team that supports the director in performing the functions defined above.
Ability to effectively negotiate with regulators when current law or regulations are not clear or subject to interpretation.

Nice To Haves

Graduate Education preferred.
Experience with multi-state health insurance regulation is desired.
Knowledge of the Utah health community, including public and private entities and their role in the provision of health care to Utah residents preferred.

Responsibilities

Develops and implements a compliance program that meets standards with HIPAA, CMS - Medicare/Medicaid, ERISA, relevant insurance regulations and other applicable federal, state, and local laws and regulations in a scalable fashion.
Develops and manages the privacy and security program as it relates to the health plan.
Chairs the Compliance Committee.
Provides advice, guidance, and oversight with the resolution of compliance questions or issues that arise in the business.
Develops corrective action plan in instances of non-compliance.
Tracks new laws, regulations and other guidance applicable to the health insurance and benefits markets that apply to the services offered by UUHP.
Acts as a subject matter expert, answer questions, and create compliant, creative solutions.
Brings significant issues to the attention of Senior Leaders and the Board of Directors with recommendations for solutions. Oversees the implementation of solutions. Ensures system for anonymous reports of non-compliance.
Prepare the compliance program for review and survey and accreditation processes by external monitoring agencies, such as Utah Department of Health, CMS, or NCQA.
Possesses an in-depth knowledge of state insurance regulation and maintain positive working relationships with state regulators. Ensures that all products, contracts, and services meet regulatory requirements.
Conducts research for and obtains approval of all new products subject to regulation.
Maintains a strong working knowledge of all federal regulations and data sharing requirements that apply to UUHP products and services (federal insurance exchange, Medicare and Medicaid).
Ensures that UUHP staff and management are informed about current regulatory compliance requirements and expected changes to regulation so that appropriate planning occurs.
Maintains positive working relationships with CMS regulators.
Develops and maintains the fraud, waste, and abuse program. Including software needs, oversight of investigations, and collaboration with MFCU and OIG.
Manages staff and external vendors providing fraud, waste and abuse services. Tracks and reports recoveries.
Writes, reviews, and maintains approval for policies and procedures, ensuring that both the departmental and organizational needs are met.
Identifies, develops, and oversees the educational and training needs of the staff.
Performs other related duties and special projects as assigned.