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Why This Role is Important to Us:

Under direction of the Compliance Manager, , the primary focus of this position is the day to day coordination of oversight activities for CCA's First Tier, Downstream, Related Entities (FDR) and Medicaid Material Subcontractors (MS), also known as the FDR MS Program. This includes review of contract and policy documents, coordinating attestations, regular meetings and progress tracking from business owners, outreach to vendors, providers, and other entities. This position is also responsible for maintaining and developing monitoring specific to the FDR program, as well as responsibility for first-level Compliance review in onboarding of new business contracts.

What You'll Be Doing:

• Within the established framework, gathers, assesses, and reviews key FDR MS entity information, including but not limited to contracts, policies and procedures, training documentation, and other critical information.

• Analyzes FDR MS entity activities, including monitoring data for risk identification and mitigation

• Interviews FDR MS business owners and entity contacts due to needs of the program, Medicare, or Medicaid.

• Coordinates, with the Compliance Manager, regular meetings with all FDR MS business owners.

• Hold meeting dates and times on a mutually agreed schedule

• Attend with department staff, communicating key compliance requirements and hearing out business owner concerns

• Communicate research requests to Compliance's central intake, and if assigned, conducting research on regulatory topics

• Assist business owners with taking on nature of business ownership, responsibilities, and connections to FDR MS entities' contacts

• Provide recommendations and works with business owners to create controls and procedures, such as policy documents, standard operating procedures, risk appetite, and other key Compliance management for business unit concepts

• Followup with business owners on new policies, procedures, etc. to confirm changes for Compliance needs are working

• Coordinates, with the Compliance Manager regular meetings and reviews with the FDR MS business itself

• Assesses FDR MS business entity's readiness to undertake Compliance program requirements

• Confirms business entity understands roll-down from CCA to entity in terms of regulatory requirements

• Communicates and plans discussions on best practices with FDR MS entities around Compliance program feature in a cooperative and supportive environment

• Performs, in coordination with other team members, reviews for both business entity and provider contracts regarding general Compliance concerns and FDR MS specific concerns, including formulation of possible solutions and resources needed.

• Provides recommendations for potential corrective action plans regarding risks and compliance concerns relating to FDR MS entities.

• Provides support for quarterly FDR MS business owner group meeting, including but not limited to presentations, research, coordination of schedules, and summarizing meeting outcomes for recommendation to CCA Compliance leadership.

• Prepares briefings, metrics, and graphics on the progress of the FDR MS program for dissemination to FDR MS business owners, Compliance, and CCA leadership.

• Regularly reviews vendor contracts to identify scope of work changes

• Identifies requirements from vendor contracts which identify a need for monitoring by the business owner

• Works with FDR MS business owners and fellow Compliance team members on developing clear, reportable, and concise metrics

• Collects monitoring plans, develops monitoring mapping to cloud software, and extracts into format usable in analytical database

• Works collaboratively with Business Intelligence unit and fellow Compliance team members to manage, augment, and deploy monitoring dashboards to FDR MS business owners, Compliance leadership, and CCA leadership

• Provides feedback on FDR MS program improvements and opportunities.

• Research, review and analyze state and federal regulations and requirements, as requested:

• Assist, when required, in processing regulatory guidance. These include but are not limited to, HPMS Memoranda, Federal Register, and/or OIG notifications and other regulatory guidance. Create summaries of changes to requirements and regulations, and identify business owners, impacted departments and required next steps for implementation. Coordinate distribution, comment collection and submission process for updated regulations.

• Serve as Regulatory Affairs and Compliance liaison with key internal departments (non-FDR MS)

• Provide guidance and assistance as requested

• Hold meetings with department leadership at agreed upon intervals

• Attend department staff meetings and present information as requested

• Assist in development of regulatory tool-kits and instruction materials as needed to assist departments with regulatory projects and process implementation

• Support business units in interpretation of regulations related to their applicable areas as well as provide assistance in developing appropriate tools to ensure compliance

• Provide consultation with business owners in developing policies and procedures and/or building internal workflows to ensure internal controls of high risk regulatory requirements are in place and working effectively

• Support communications, data collection, organization and submission of materials for external reviews and audit requests, as required

• Assist in the oversight of the corporate Compliance Plan and identification of compliance risks

• Assist in maintaining an effective compliance plan at CCA by promoting compliance with all compliance plan elements

• Develop new processes and/or programs as directed

• Serves as scribe and note taker during committee meetings, voluntarily or as assigned.

Other duties as assigned

What We're Looking For:

• Bachelor's degree or equivalent work experience is required.

• Demonstrated experience in building ways to amass large amounts of data, then leveraging statistical tools (Excel etc.) to display key data for business planning.

• Experience with guiding different workgroups with different experience levels towards a common goal.

• Experience in presenting with professional decorum while communicating with internal and external stakeholders.

• 1-2 years' work experience in health care strongly preferred.

• 1-2 years work experience in customer service, analytics, contracting, federal government policy, or software implementation preferred. (internships included)

• Regulatory compliance experience preferred; health care compliance programs experience strongly preferred.

• Experience with review of contracts, federal and/or state regulations preferred.

A background with Medicare, Medicaid and/or health plan operations preferred. Experience with health care compliance programs is also preferred.

• Strong active engagement and situational awareness skills -- having the focus to actively listen and interact with differing levels of any business unit, and the awareness to ask key questions in a diplomatic manner as they come to mind.

• Strong written, verbal, listening and communication skills -- having the ability to understand and communicate appropriately to the targeted audience.

• Strong analytical skills -- having the ability to identify an issue, conduct an analysis to determine business impact (including gap analysis), troubleshoot and identify solutions.

• Candidate must be able to prioritize work, pivot activities due to priority requests, and use independent judgment.

• Self-directed with effective reporting and communication skills.

• Ability to provide advice and recommendations while maintaining independence and objectivity.

• Ability to view requirements and expectations in perspective of organizational and regulatory goals.

• Strong research skills.

• Strong presentation skills.

• Project management education or skills are preferred.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/RN license (if applicable). Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws.