SUPERVISOR, COMPLIANCE (2805)

VIVANT HEALTH•Sacramento, CA

1d•Onsite

About The Position

The Compliance Supervisor (Supervisor) has a clinical license and reports to Vivant’s Compliance Senior Manager and plays a key role in supporting and strengthening Vivant’s Compliance Program and department operations. The Supervisor is responsible for day-to-day operations and direct supervision and support of the team responsible for the intake and response to document requests and information needed to resolve member grievances and appeals. The Supervisor is responsible for conducting internal audit UM audits. The Supervisor is responsible for reviewing and presenting reports on trends related to documents gathered and any trends from the grievances and appeals requests and UM audits.

Requirements

Minimum five (5) years of full-time experience in healthcare is required.
Minimum three (3) years of healthcare quality, grievance and appeals, or clinical compliance audit experience is required.
Strong understanding of IPA and medical clinic operations, compliance, and quality programs.
Ability to independently develop and draft policies and procedures.
Ability to develop and present training materials.
Experience with project management and organization.
Self-motivated and able to take initiative and think creatively.
Strong organizational, multi-tasking, planning, and follow up skills.
Excellent communication skills, including both oral and written.
Must have strong skills in Microsoft software (Word, Excel, PowerPoint).
Must be able to develop formulas and create dashboards in Excel.
Excellent active listening and critical thinking and analytical skills.
Ability to proactively and effectively solve advanced-level problems with minimal supervision.
Leadership skills, including diplomacy, integrity, independence, and trustworthiness, with the ability to command respect from senior management, executives, governing bodies, and colleagues.
Ability to multi-task, exercise excellent time management, and meet multiple deadlines.
Ability to exercise sound discretion and strict maintenance of confidentiality of all confidential and sensitive communications and information.
Ability to provide and receive constructive job and/or industry related feedback.
Excellent attention to detail and ability to document information accurately.
Ability to effectively and positively work in a dynamic, fast-paced team environment and achieve objectives.
Demonstrate commitment to the organization’s mission.
Must have the ability to quickly learn and use new software tools.
Must have mid-level skills using e-mail applications.
Ability to develop and maintain positive working relationships.
Collaborative mindset with an open management style and ability to build partnerships.
Ability to work independently as well as in a team environment.
Ability to present self in a professional manner and represent the Company image.
High School Diploma or GED is required.
Graduated from an accredited school of nursing is required.
Active and unrestricted Licensed Vocational Nurse License required.

Nice To Haves

Managed care is preferred.
Typing speed of 45 wpm or more is a plus.

Responsibilities

Supervise daily operations of requests for documents related to health plan grievances and appeals requests and ensure timely response to health plans.
Provide operational coverage, including onsite and alternative schedules as needed.
Identify and resolve workflow and procedural inefficiencies.
Serve as the primary liaison between health plans and internal business units and coordinate a response for document requests and/or resolution of requests for information and action related to grievances and appeals originating from DMHC, DHCS, and CMS.
Serve as the primary liaison between health plans and internal business units and coordinate a response for documents requests and/or resolution of potential quality issues (PQIs).
Analyze daily, monthly, and quarterly operational and production data.
Identify trends, root causes, and mitigation strategies.
Review and present qualify of care and qualify of service trend reports from the grievance and appeal requests by health plan and clinic.
Conduct regular audits of UM records requested by health plans and others to ensure compliance with internal policies, regulatory standards and best practice guidelines.
Provide comprehensive feedback to clinical teams and leadership on audit results, offering constructive recommendations for improving quality and compliance.
Develop and update clinical audit tools to meet the needs of the various lines of business.
Manage staffing, including scheduling, cross-training, and coverage.
Conduct regular 1:1 meetings; provide ongoing training and support to ensure staff competency; and address performance issues with appropriate documentation and escalation.
Advise leadership on opportunities to improve documents requests processes and department efficiency and effectiveness.
Develop, implement, and maintain policies, procedures, workflows, and training materials, Coordinate updates to desktop procedures and training manuals.
Ensure documentation accuracy, version control and accessibility.
Support the operations of the Compliance Committee by preparing materials and following up on assigned action items
Lead assigned projects by designing effective processes, conducting necessary research, and creating and implementing project plans to monitor and support departmental and cross-functional initiatives.
Performs related duties consistent with the scope and intent of the position.
Regular attendance.
Travel as required.
Enforces Company policies and safety procedures.
Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
Maintain IPA, Health Plan compliance standards.