Vice President, Chief Compliance Officer

Date: Jan 17, 2023

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 8634 

 

Position Summary/Position

 

Under the direction of the CEO and Board of Directors, the Vice President, Chief Compliance Officer (VP Compliance) will collaborate with the Executive Team, senior leadership team, and external consultants as needed to implement and facilitate the organization’s Compliance Program. 

The VP Compliance is a key leadership role that acts as the Chief Compliance Officer and is responsible for providing strategic and operational leadership pertaining to compliance and regulatory issues as well as oversight of the enterprise-wide comprehensive compliance program that includes both Medi-Cal and Medicare Compliance Programs that meet and exceed the OIG’s compliance guidance components and elements of an effective program. The VP Compliance also oversees the development of a compliance risk management program to assess, prioritize, and manage regulatory and legal compliance risks based on state and federal guidelines and requirements through the systematic assessment and management of compliance risks.  

The VP Compliance is also responsible for enterprise-wide confidential reporting systems allowing employees, customers, contractors, and other stakeholders to disclose violations of the corporation's ethical standards, violations of law, or corporate policy relating to such matters without fear of retaliation

The VP Compliance will ensure alignment with the mission, core values, policies, and strategies of IEHP. The VP Compliance will ensure accountability and compliance with applicable legal, governmental, and regulatory requirements.

Major Functions (Duties and Responsibilities)

 

The Vice President, Chief Compliance Officer acts as the Chief Compliance Officer for IEHP and is responsible for the overall strategic direction and implementation of the Compliance Program. Duties include, but are not limited to: 
1. As a member of the leadership team, participate and contribute to the overall IEHP Mission, Vision and Strategic priorities, as established by the CEO and Board of Directors.
2. Provide strategic direction and advise on IEHP’s compliance program design, implementation and monitoring.
3. Provide executive strategic leadership to Compliance operations including the development and distribution of written standards of conduct, policies and procedures that promote the organization's commitment to compliance. 
4. Review the content and performance of the Enterprise-wide Compliance Program, including compliance policies and procedures and code of conduct on a routine basis and takes appropriate steps to ensure its effectiveness to prevent, detect, and correct illegal, unethical, or improper conduct with the organization.
5. Develop, implement, and present regular compliance and risk management training and education to executive staff and the Board of Directors at least annually and as needed. Such training includes introductory compliance training, as well as ongoing training on compliance related topics as needed.
6. Provide executive oversight and maintenance of the compliance hotline and processes to receive and resolve complaints and concerns; development and management of policies and processes to respond to allegation of improper or illegal activities; auditing and monitoring to ensure compliance with applicable regulations, policies and OIG elements of an effective compliance program. 
7. Provide executive oversight of IEHP’s Fraud, Waste and Abuse (FWA) and Special Investigations Unit (SIU) programs.
8. Establish development and strategic oversight of processes to ensure non-employment/engagement of individuals or entities excluded from participation in State and Federal health care programs (sanction and exclusionary check).
9. Ensure appropriate enterprise-wide policy development, staff education, investigations of alleged regulatory and policy violations, compliance monitoring, and auditing.
10. Serve as the Chair for the Compliance Committee and serves in an advisory capacity to keep executive leadership and senior management informed on the operation and progress of the organization’s compliance efforts.   
11. Oversee the development, implementation, and maintenance of an effective compliance communication by partnering with various departments such as Legal, Human Resources, Operations and other departments as required.  
12. Provide real-time guidance to business unit leadership related to the timely and effective dissemination and interpretation of regulatory requirements and changes. Work with the Operations leaders to ensure timely and effective operational implementation and oversight of new regulatory requirements and changes.
13. Work collaboratively with operational leaders, medical directors, staff, network providers and first tier, downstream and related entities (FDRs) in leading external regulatory audits.
14. Budget, recruit, manage, develop, and retain the necessary resources to successfully perform the Compliance function.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Total experience should include a required minimum of ten (10) years of compliance experience in managed care with at least five (5) years of senior management experience.

Education Qualifications

 

Master’s Degree, such as but not limited to MPH, MPA, or MHA from an accredited institution required.  

Professional Certification

 

Certified in Healthcare Compliance (CHC) on hire or within six (6) months of hire date.

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Subject matter expertise level knowledge of federal and state health care compliance laws and regulations, OIG enforcement methods, and other applicable federal and state compliance guidance, as well as industry best practices in compliance.  Ability to understand, interpret, and apply complex state and federal health care compliance laws, rules, regulations and guidelines; perform research analysis of health care laws, regulations, and policies. Extensive knowledge of Medi-Cal and Medicare rules and regulations, and managed care in California. Demonstrated understanding and sensitivity to diverse and multi-cultural environment and community.

Skills Requirement

 

Excellent writing, interpersonal communication and organizational skills in a variety of situations.   Proficient with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) to effectively track and manage deliverables. Demonstrated ability to develop and deliver comprehensive compliance training and education to all levels of staff, including members of the Board of Directors. 

Abilities Requirement

 

Ability to understand, interpret and apply complex state and federal healthcare compliance laws, rules, regulations and guidelines; perform research and analysis of healthcare laws, regulations and policies.  Develops high levels of credibility and accountability.  Leads by influence with transparency and develops direct reports.  Ability to establish and maintain collaborative, credible, trusting partnerships with individuals across a broad range of people and groups, both internal and external.   Works well under pressure, producing high quality results. 

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

General office environment; word processing and data entry involving computer keyboard, mouse, and screens; automobile travel within California.

The incumbent approved to be hybrid may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership.

Work Model Location

Hybrid

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Other - FREQUENTLY
Use of computer mouse - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Hearing: In a group - FREQUENTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Communicate: Verbally engage with customer base - FREQUENTLY
Communicate: Give instructions, advise, warn, instruct - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Sitting - CONSTANTLY
Indoors - FREQUENTLY
Lighting - CONSTANTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Regular contacts: recurring clients - FREQUENTLY
Perform complex and varied tasks - CONSTANTLY
Develop and maintain positive work relationships - CONSTANTLY
Decision-making - CONSTANTLY
Lead/Influence Others - CONSTANTLY
Work review - FREQUENTLY
Rapid Pace of work - FREQUENTLY
Control of work pace - FREQUENTLY
Pace of work with faster/slower work periods - FREQUENTLY
Problem Solving - CONSTANTLY
Memory - CONSTANTLY
Understand and follow direction - CONSTANTLY
Regular and reliable attendance - CONSTANTLY

A reasonable salary expectation is between $240,676.80 and $330,928.00, based upon experience and internal equity.

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles