Senior Director Detection Correction and Vendor Oversight

Looking for a subject matter expert in the healthcare regulatory & compliance space, with acumen and passion in fostering a culture of compliance. This role will report to the VP and Compliance Officer. The Sr. Director provides comprehensive compliance leadership and oversight to all lines of Medica's business. The Sr Director leads business strategies to all aspects of Medica's compliance oversight program to prevent, detect, and correct identified issues as an expert in the field. The incumbent provides leadership and strategic guidance on compliance functions, including maintaining an effective compliance program, implementation of new laws and regulations, oversight to Medica's delegated vendor oversight program, auditing, monitoring, and corrective action. The position will closely coordinate and collaborate with enterprise-wide stakeholders to achieve business objectives and maintain a legally and practically effective compliance program.

Key Accountabilities:

• Effective Detection and Correction for Medica
  
  
  
  • Oversee compliance department auditing and monitoring and delegated oversight functions.
  • Directs risk ongoing identification and reporting and provides oversight to ensure auditing and monitoring plans are in place for all lines of Medica's business to detect and correct risk for Medica.
  • Create, integrate, and implement new protocols, guidelines, policies and procedures and audit tools.
  • Ensure consistent monitoring documentation standards are met for new laws, regulations and audit findings.
  • Manage the corrective action process and encourage timely follow up across departments.
  • Provides direction to business leads in support of state and federal regulations for all lines of business; prepare for audit readiness, such as mock audits and overseeing the implementation of any resulting corrective action.
  • Provides direction and strategic planning to business teams to ensure consistent delivery of measurable results; identifies and resolves barriers for business teams as necessary.
  • Prepare reports of compliance audit findings and recommendations for Quarterly Compliance Committee and Audit Committee of the Board.
  • Assist with responding to government investigations, probes, audits, and queries in coordination with Legal and other stakeholders.
  • Assist with updates to compliance related training and awareness- speak up culture materials.
  • Build deep relationships and create strategic alliances to establish trust with key stakeholders across the enterprise.
  • Proactively identify process gaps, roadblocks, bottlenecks, and inefficiencies that will negatively impact risk and compliance efforts and mitigate them.
  • Develop, monitor, and report on a suite of KPIs for various internal reviews including Executive Leadership and Board-level reporting.
  
  
  
  
• Effective Vendor Oversight Program Across all Lines of Medica's Business
  
  
  
  • Provides strategic leadership and direction to all functional components of the Vendor Oversight Program, supporting staff, and others who are directly accountable for the operations of the program.
  • Directs vendor oversight manager and committee in developing auditing and monitoring plans to detect and correct risk for Medica as it relates to vendor activity and audit readiness.
  • Provides leadership direction and approvals as it pertains to new pre-delegation audits, and annual reviews of primary delegated vendors to ensure compliance in preparation for CMS first tier and downstream audit readiness.
  • Approves work plan design, objectives, policies and procedures, and overall direction of the Vendor Oversight Committee and workgroup.
  • Provides direction and oversight to the first-tier vendor and provider training requirement and compliance program effectiveness to ensure contractual requirements, best practices, and requirements are met in preparation for audit readiness, including disclosure of ownership and excluded entity validation.
  
  
  
  
• Leadership/Team Management




• Lead, mentor, and develop high-performing team, fostering a culture of accountability and continuous improvement.
• Establish clear performance metrics and conduct regular evaluations.
• Promote a positive and productive work environment.
• Ability to delegate responsibility and authority to team members.

Qualifications:

• Bachelor's degree or equivalent experience, plus 10+ years of work experience
• Minimum of five years of compliance experience
• Minimum of five years of management experience
• Solid understanding of health care/managed care industry including knowledge of managed care operations, customer needs and cost trends
• Progressive understanding of regulatory environments and compliance program guidelines, including state and federal laws
• Advanced understanding of HIPAA Privacy and Security requirements and implementation standards
• Demonstrated minimum of five years of success leading teams and managing/executing complex projects across organizations through verbal and written communication.

Skills and Abilities:

• Must be able to appropriately challenge "conventional wisdom."
• Must be able to develop innovative solutions that balance legal and business needs.
• Must demonstrate exceptional analytical strategical planning, issue identification and resolution skills.
• Ability to analyze situations and make appropriate decisions.
• Proven ability to communicate effectively with all levels of an organization.
• Demonstrated ability to organize complex information and effectively report information to senior management.
• Ability to develop and deliver training to staff.
• Ability to operate independently and manage multiple, complex projects with a high degree of initiative required.
• Significant knowledge of fraud and abuse, state, and federal requirements.

This position is an Office role, which requires an employee to work from the designated office, Minnetonka on average, 2+ times per week.

The full salary range for this position is $143,500 - $246,000. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.