IMPLMNT DIR-POLICY & PROGRAMS

State of careers Rhode Island

About The Position

GENERAL STATEMENT OF DUTIES: To be responsible for the development, implementation and administration of broad policies and programs that affect all areas for the efficient operation of all departments of state government. SUPERVISION RECEIVED: Works under the administrative direction of a superior with wide latitude in the exercise of independent initiative and judgement; work is subject to review through conferences and written reports for satisfactory performance and conformance with prescribed policies and procedures. SUPERVISION EXERCISED: To plan, coordinate and supervise the work of a staff as required. ILLUSTRATIVE EXAMPLES OF WORK PERFORMED: To be responsible for the development, implementation and administration of broad policies and programs that affect all departments of state government for their more efficient operation. To coordinate reorganization of major services to ensure a smooth and efficient transition. To assist in establishing policy and program priorities in relation to short and long range goals and objectives. To assist in a program of studies in order to develop comprehensive approaches towards the effective utilization of economic and human resources. To perform or otherwise coordinate evaluations and auditing processes to determine results of programs instituted in the areas of: annual savings, increased revenues, improved cost controls, cost avoidances, and other efficiencies and economic results. To be responsible for the continuing monitoring of programs and services instituted for management and financial impact over the long term. To prepare written reports as required regarding the results of various policies and programs instituted. To establish and maintain effective working relations with all departmental officials. To do related work as required. The Implementation Policy Director Policy & Programs will serve as the Compliance Officer for the for the Managed Care Organizations (MCO’s) and the Non-Emergency Medical Transportation (NEMT) vendor for the Managed Care & LTSS/FIDE population. This position reports to the Compliance Director and will be responsible for Contract Compliance Management and Oversight for the MCO’s (MCO), Dental vendor and Non-Emergency Medical Transportation (NEMT). Compliance Officer – Managed Care Programs The Compliance Officer is responsible for overseeing and ensuring adherence to all applicable State of Rhode Island and Federal compliance requirements, including Medicaid Managed Care regulations and the managed care delivery system in Rhode Island. This role plays a critical part in monitoring vendor performance, contract compliance, and regulatory accountability across multiple managed care programs. Key Responsibilities • Ensure compliance with all Rhode Island State and Federal laws, regulations, policies, and contractual requirements related to Medicaid Managed Care. • Manage and oversee Contract Compliance for Managed Care Organizations (MCOs), the Dental Plan, and Non-Emergency Medical Transportation (NEMT) vendors operating within Rhode Island. • Conduct comprehensive compliance audits and reviews, including desk audits and operational assessments, to evaluate vendor adherence to contractual and regulatory standards. • Review and analyze monthly, quarterly, and annual reports submitted by MCOs, Dental Plan, and NEMT providers to ensure accuracy, completeness, and compliance with Rhode Island Medicaid requirements. • Identify compliance issues, deficiencies, and areas of risk; document findings and communicate results to vendors and internal leadership. • Develop, monitor, and track Corrective Action Plans (CAPs) in response to identified findings and ensure timely resolution. • Participate in and contribute to monthly vendor oversight meetings, including presenting findings, discussing performance issues, and monitoring remediation efforts. • Develop, maintain, and update Standard Operating Procedures (SOPs) to support compliance operations, monitoring activities, and regulatory requirements. • Assist with Fully Integrated Dual Eligible (FIDE) program implementation, including compliance support activities related to dual-eligible members in Rhode Island. • Collaborate with internal and external stakeholders to support FIDE operational readiness, ongoing compliance monitoring, and regulatory reporting. • Serve as a subject matter expert on Rhode Island Medicaid Managed Care compliance requirements and provide guidance to internal teams and contracted vendors. • Maintain accurate and complete documentation related to audits, reviews, findings, corrective actions, and compliance activities. • Support continuous process improvement initiatives to strengthen compliance oversight and program integrity.

Requirements

A thorough knowledge of the modern principles and practices of all phases of general administration
A thorough knowledge of administrative planning, programming, direction and evaluation of organizational structures of state government and the functions of its departments and agencies
The ability to identify problems and establish priorities and goals in the improvement of management of state government operations
The ability to establish and maintain effective working relationships with state and other officials
A Master of Science Degree in an administrative specialty
At least 5 years of employment in a responsible supervisory and administrative capacity with ultimate responsibility for the development, implementation, and administration of efficient policy and programming
Demonstrated knowledge of Rhode Island Medicaid, Medicaid Managed Care, and applicable State and Federal compliance guidelines.
Strong auditing, analytical, and problem-solving skills, with the ability to interpret regulatory and contractual requirements.
Experience reviewing healthcare compliance reports, performance metrics, and vendor deliverables.
Excellent written and verbal communication skills, including the ability to present findings clearly and professionally.
Strong organizational skills and attention to detail, with the ability to manage multiple priorities and deadlines.
Ability to work collaboratively with leadership, vendors, and cross-functional teams while maintaining objectivity and regulatory integrity.

Responsibilities

Ensure compliance with all Rhode Island State and Federal laws, regulations, policies, and contractual requirements related to Medicaid Managed Care.
Manage and oversee Contract Compliance for Managed Care Organizations (MCOs), the Dental Plan, and Non-Emergency Medical Transportation (NEMT) vendors operating within Rhode Island.
Conduct comprehensive compliance audits and reviews, including desk audits and operational assessments, to evaluate vendor adherence to contractual and regulatory standards.
Review and analyze monthly, quarterly, and annual reports submitted by MCOs, Dental Plan, and NEMT providers to ensure accuracy, completeness, and compliance with Rhode Island Medicaid requirements.
Identify compliance issues, deficiencies, and areas of risk; document findings and communicate results to vendors and internal leadership.
Develop, monitor, and track Corrective Action Plans (CAPs) in response to identified findings and ensure timely resolution.
Participate in and contribute to monthly vendor oversight meetings, including presenting findings, discussing performance issues, and monitoring remediation efforts.
Develop, maintain, and update Standard Operating Procedures (SOPs) to support compliance operations, monitoring activities, and regulatory requirements.
Assist with Fully Integrated Dual Eligible (FIDE) program implementation, including compliance support activities related to dual-eligible members in Rhode Island.
Collaborate with internal and external stakeholders to support FIDE operational readiness, ongoing compliance monitoring, and regulatory reporting.
Serve as a subject matter expert on Rhode Island Medicaid Managed Care compliance requirements and provide guidance to internal teams and contracted vendors.
Maintain accurate and complete documentation related to audits, reviews, findings, corrective actions, and compliance activities.
Support continuous process improvement initiatives to strengthen compliance oversight and program integrity.

Benefits

For information regarding the benefits available to State of Rhode Island employees, please visit the Office of Employee Benefits' website at http://www.employeebenefits.ri.gov/.
Also, be advised that a new provision in RI General Law 35-6-1 was enacted requiring direct deposit for all employees. Specific to new hires, the law requires that all employees hired after September 30, 2014 participate in direct deposit. Accordingly, any employee hired after this date will be required to participate in the direct deposit system. At the time the employee is hired, the employee shall identify a financial institution that will serve as a personal depository agency for the employee.

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