20068603 - Director of Compliance & Performance Monitoring (Administrative Staff)

State of Ohio • Columbus, OH

23d • Onsite

About The Position

The Director of Compliance & Performance Monitoring oversees the unit responsible for vocational rehabilitation regulation, managed care organization (MCO) reporting and compliance, Employer Substance Use Prevention and Recovery (SUPR) program compliance, operational quality assurance, and operational policy. The role oversees administration of the Annual Monitoring Plan, which monitors and regulates pharmacy rebate aggregators, Pharmacy Benefit Managers (PBMs), and MCOs, while ensuring operational quality standards and policies are maintained.

The director creates or ensures implementation of monitoring plans, procedures, policies, quality assurance initiatives, and operational policy guidelines. The role identifies process improvements and recommends internal controls through Compliance Analysis Reports, operational quality assurance reviews, and operational policy development and updates. It accesses and controls high-level confidential and legal documents, provides confidential advice to front-line departmental managers, and advises the Division Chief, directors, PBMs, and MCOs on monitoring, operational quality, and policy matters.

The position has personnel management responsibilities, including hiring, promoting, disciplining, and terminating subordinate staff as appropriate. It also performs other unclassified and fiduciary duties, including developing and delivering complex presentations to the Chief and other BWC executive staff. The position is permanent, full-time, overtime-exempt, and requires travel. Employees must provide their own transportation and/or legally operate a state-owned vehicle. The final external applicant must pass a pre-employment drug test and an extensive Ohio State Patrol background check.

Requirements

• Experience overseeing operational compliance, including adherence to policies and procedures.
• Knowledge of budgeting, accounting, management, labor relations, workforce planning, employee training and development, public relations, human relations, BWC and MCO policies and standard operating procedures, counseling, interviewing, business, state and federal laws pertaining to PBMs and MCOs, vocational rehabilitation services, operational policy and procedure development, quality assurance standards, SUPR management reports, monitoring programs, and leadership.
• Skill with medical bill adjudication software, MS Office, and data analytics software such as Tableau or Cognos.CoreSuite and CAM.
• Ability to exercise personal and sound business judgment in varied business scenarios; deal with complex variables and determine appropriate action; use statistical analysis; complete complex position papers; maintain accurate records; originate routine business letters reflecting standard and non-standard policies and procedures; interview job applicants effectively; understand complex technical manuals and verbal instructions; prepare and deliver speeches to specialized audiences and the general public; gather, collate, and classify information about data, people, or things; portray a professional image and create a friendly atmosphere as a management staff member; and maintain loyalty, trust, and confidence.
• Must provide own transportation and/or legally operate a state-owned vehicle because the position requires travel.
• Must pass a pre-employment urinalysis for illegal drug use and an extensive Ohio State Patrol background check.

Nice To Haves

• Bachelor’s or master’s degree in Business Administration, Public Administration, Accounting, Finance, Organizational Leadership, or a related field.
• Strong working knowledge of accounting principles, organizational policy, and quality assurance standards.
• Experience with financial reporting and internal controls.
• Ability to interpret and apply organizational policies and quality assurance practices in a compliance and performance monitoring environment.

Responsibilities

• Oversee the Compliance & Performance Monitoring unit, including vocational rehabilitation regulatory work, MCO reporting and compliance, SUPR program compliance, operational quality assurance, and operational policy.
• Oversee the Compliance management team’s administration of the Annual Monitoring Plan for pharmacy rebate aggregators, PBMs, and MCOs.
• Ensure operational quality standards and policies are maintained.
• Create or ensure implementation of monitoring plans, procedures, policies, quality assurance initiatives, and operational policy guidelines.
• Identify process improvements and recommend internal controls through Compliance Analysis Reports, operational quality assurance reviews, and operational policy creation and updates.
• Access and control high-level confidential and legal documents and provide confidential advice to front-line departmental managers.
• Advise the Division Chief, directors, PBMs, and MCOs on monitoring processes, operational quality, and policy matters.
• Hire, promote, discipline, and terminate subordinate personnel as appropriate and necessary.
• Develop and deliver complex presentations concerning monitoring, operational quality assurance, and operational policy, including presentations to the Chief and other BWC executive staff.
• Perform other unclassified and fiduciary duties and functions as required.

Benefits

• Medical coverage.
• Free dental, vision, and basic life insurance premiums after completion of the eligibility period.
• Paid time off, including vacation, personal, and sick leave, and 11 paid holidays per year.
• Childbirth, adoption, and foster care leave.
• Education and development opportunities, including employee development funds and Public Service Loan Forgiveness.
• Public retirement systems, including OPERS, STRS, SERS, and HPRS, and optional deferred compensation.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed