Compliance Program Manager

Compliance Oakland, California


Description

The Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities.

 

The Compliance Program Manager will serve as Compliance lead. This position works closely cross functionally to maximize operational and financial efficiency and to ensure CEI compliance with state and federal regulations. This position will report to the Director of Contracts and Compliance.

 

Duties and Responsibilities

  • Manage day-to-day operation of CEI's Compliance
  • Develop, initiate, maintain, and revise policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
  • Monitors CEI’s completion of Quarterly Reviews of all CEI policies and

 

 

  • Review and analyze regulations and regulatory changes based on knowledge of CEI and the PACE model to assess potential impacts on CEI and provide guidance to management and employees.
  • Maintain a tracking system of regulatory changes to record the Compliance Department’s response to such changes.
  • Maintain and track required licenses to ensure that CEI facilities are appropriately
  • Coordinate and conduct audits of CEI's contracted providers (i.e. annual site visits of RCFE’s and SNF’s) as well as internal audits (including Environment of Care rounds of PACE centers) in collaboration with Quality
  • Support CEI departments in implementation of corrective action
  • Support Department Lead in preparing for and coordinating audits or inspections by external regulatory bodies, including federal, state, and local
  • Monitor and maintain compliance with regulatory agencies and established company procedures.
  • Coordinate quarterly compliance meetings with department managers and

  • Conduct or direct the internal investigation of compliance violations.
  • Respond to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures in an uniform manner.
  • Support department lead in acting as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and resolved.
  • Support department lead in ensuring proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
  • In coordination with CEI Leadership, ensure proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
  • Manages compliance hotline process, which includes investigation, follow-up and corrective action process as necessary.
  • Oversee medical record and subpoena request processes.

 

Qualifications Required

  • BA/BS Required.
  • Certification in Healthcare Compliance (CHC) or Privacy, Privacy and Security (CHPS) preferred.
  • Advanced proficiency in MS Office, Excel and Word programs.
  • 3- 5 years of experience in healthcare compliance and familiarity with operational, financial, quality assurance, and human regulation procedures and
  • 1-3 years of experience working for a PACE program highly
  • Knowledge of DHCS, CMS regulations required.
  • Knowledge of contracting, legal and the healthcare
  • 1-3 years of experience working with regulators (e.g. coordinating audits, processing licenses, submitting applications to notify regulators of changes in executive leadership, Board members, submitting service area/site expansion applications) both at State and Federal level.
  • Knowledge of regulatory agency requirements, State and Federal
  • Collaborative and works effectively as a team member with strong interpersonal
  • Strong attention to detail and organization
  • Ability to perform under tight deadlines and thrive in a fast-paced environment
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information

 

The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required. CEI reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program.

All employees are expected to perform their duties within their ability as required by the job and/or as requested by management.

 

Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.