Manager, Ethics & Compliance

Sutter Health•Sacramento, CA

10h

About The Position

Assists in the administration of Sutter Health Ethics and Compliance Program (Program) in accordance with applicable state and federal laws, regulations and standards (e.g., Department of Health and Human Services Departments, the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG), the California Department of Managed Health Care (DMHC). Manages and coordinates key Program functions at the system level, including overseeing project management and performance improvement activities, developing communications and reporting systems, and measuring the program's performance and effectiveness. Provides overall accountability for all facets of approved compliance projects and initiatives from inception through completion to enable alignment, standardization, and efficiency at the affiliate, operating unit (OU), and system levels. Establishes and implements effective project management processes and methodologies to ensure projects are on time, within budget, adhere to high quality standards, and meet stakeholder expectations. Administers and provides oversight for various compliance systems, tools, and databases. Develops and implements a balanced scorecard and dashboard for measuring the Program's progress and effectiveness. Plan and design training programs that address both general and specific (role-based) compliance education needs, which provides up-to-date information on current legal, regulatory, and Sutter Health policy requirements, and that build awareness of the Program, processes, and potential legal ramifications. Conducts an ongoing and comprehensive review of regulatory and Sutter Health policy changes and facilitates the dissemination of new information with the organization, based on need.

Requirements

Bachelor's degree in Business, Healthcare, Informatics, Pre-Law, Project Management, or related field or equivalent education/experience.
CHC-Certified in Healthcare Compliance within 1 Year of hire.
8 years recent relevant experience.
Demonstrated management of an effective ethics and compliance program, including infrastructure development; policy management; training; monitoring/auditing; conducting and documenting investigations; addressing and resolving violations, errors, and deficiencies; tracking corrective actions, performing risk assessments, and designing strategies to prevent future compliance problems.
Thorough understanding of healthcare compliance standards, compliance program development and assessment, relevant healthcare operational issues, business ethics and compliance risks and the knowledge to effectively manage those risks in a dynamic healthcare environment.
Strong knowledge and understanding of current regulations that govern healthcare operations, including Office of Inspector General (OIG) Work Plan, Affordable Care Act and Health Insurance Portability and Accountability Act (HIPAA) regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, and privacy and consent laws.
Familiar with current and emerging compliance topics and well versed in project management methodologies and tools, resource management and change management techniques.
Strong business acumen; solid negotiation, risk management, and consensus building skills; in addition to being an effective decision maker and expert delegator.
Developed project management skills, including the ability to initiate, plan, execute, and monitor complex projects to meet existing or new regulatory requirements and timelines.
Superior attention to detail, superior analytical and strategic planning skills with the ability to identify potential issues/risks/trend, analyze data, provide insights to staff and affiliates, and recommend actions to resolve or minimize the impact.
Exceptional communication (written/verbal), interpersonal, and presentation skills to explain regulatory requirements, directives, ideas and concepts clearly and professionally to diverse audiences and all levels of internal and external constituencies.
Advanced computer skills with competency in Microsoft Office suite (Word, Excel, PowerPoint) and Project, and the ability to perform internet-based legal and regulatory research.
Ability to partner with legal services to translate complex legal and regulatory requirements and issues into terms readily understood by management, service line and clinical personnel.
Ability to develop effective education programs for adult learners (coders, physicians, nurses, ancillary staff).
Ability to convert vision into a tangible plan and develop clear ethics and compliance goals and objectives that support the strategic plan.
Ability to advise management regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations on Sutter Health's business strategies and its not-for-profit mission.
Ability to analyze problems and issues from a variety of perspectives and understand the legal, financial, and operational impact of those decisions.
Ability to manage people, cross-functional teams, and organizational dynamics while overseeing and prioritizing multiple projects simultaneously in a a dynamic and challenging environment.
Ability to work independently, as well as part of a multidisciplinary team, while demonstrating excellent organization skills to reprioritize workloads and resources as needed.
Ability to identify and resolve technical, operational and organizational problems using policies, procedures and department plans.
Ability to foster a collaborative environment, to influence individuals or groups with diverse opinions and to enlist cooperation without direct control/authority.
Ability to maintain strict confidentiality of all compliance and risk management data, and ensure the privacy of each patient’s protected health information (PHI).
Ability to build and maintain collaborative relationships with peers, other departments, stakeholders, consultants, government agencies, and external organizations to achieve regulatory and accreditation compliance.

Responsibilities

Manages and coordinates key Program functions at the system level, including overseeing project management and performance improvement activities, developing communications and reporting systems, and measuring the program's performance and effectiveness.
Provides overall accountability for all facets of approved compliance projects and initiatives from inception through completion to enable alignment, standardization, and efficiency at the affiliate, operating unit (OU), and system levels.
Establishes and implements effective project management processes and methodologies to ensure projects are on time, within budget, adhere to high quality standards, and meet stakeholder expectations.
Administers and provides oversight for various compliance systems, tools, and databases.
Develops and implements a balanced scorecard and dashboard for measuring the Program's progress and effectiveness.
Plan and design training programs that address both general and specific (role-based) compliance education needs, which provides up-to-date information on current legal, regulatory, and Sutter Health policy requirements, and that build awareness of the Program, processes, and potential legal ramifications.
Conducts an ongoing and comprehensive review of regulatory and Sutter Health policy changes and facilitates the dissemination of new information with the organization, based on need.