Chief Regulatory Affairs & Compliance Officer

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French Camp, CA, US

4 days ago Requisition

Salary Range: $ To $ Annually

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

Under limited supervision, the Chief Regulatory Affairs and Compliance Officer is responsible for establishing and implementing an effective regulatory affairs and compliance program, including fraud, waste and abuse, to prevent illegal, unethical or improper conduct consistent with applicable laws, regulatory and accreditation standards and HPSJ policies. Oversight of the Health Plan’s legal department and management of outside counsel. The work is varied and complex and requires a high degree of discretion and independent judgment.

• Oversee the selection, retention, management and evaluation of all outside counsel.
• Recommend, develop and define the health plan’s policies and procedures.
• Provide guidance on the legal impact of new or proposed local, state, federal or managed care legislation, changes in government agency requirements, business decisions, or processes that impact the health plan in the administration of its programs.
• Evaluate and plan for remediating enterprise risk related matters as issues and initiatives arise.
• Process resolutions and execute major legal action regarding the HPSJ’s public entity status as it relates to jurisdiction, function, procedures, operations and responsibilities.
• Develop and maintain relationships with internal and external stakeholders, including federal and state regulators and trade associations.
• Identify, develop and implement strategies; oversee the development of associated business plans.
• Develop and implement HPSJ’s Compliance Program, Anti-Fraud Plan, and Annual Compliance Work Plan.
• Chair the Compliance Committee and ensure the committee meets the goals as outlined in the HPSJ Compliance Plan and Annual Compliance Work Plan.
• Monitor the performance of the compliance program, including privacy and fraud, waste and abuse, and related activities on a continuing basis.
• Review, analyze, or oversee the review and analysis of legislation, regulations, and regulatory guidance (e.g., All Plan Letters) to determine the impact on plan operations; identify the need for new or revised policies, procedures, plan documents, etc.; make recommendations to management; develop and implement as required.
• Develop and implement communication and educational programs and activities for internal and external stakeholders on compliance, and regulatory and contract requirements in an effective and timely manner.
• Conduct investigations of actual and potential privacy and fraud, waste, and abuse violations by HPSJ employees, vendors, and business associates; determine actions to mitigate violations and breaches; document and report to Executive Management or applicable regulators as required.
• Assist internal departments with the implementation, maintenance, and updates of compliance activities, including new and revised policies, procedures and corrective action plans.
• Lead the development and renewal of HPSJ’s state contracts and contract amendments.
• Develop, implement, and monitor vendor, administrative, and grant agreements/contracts processes.
• Plan for and oversee annual external audits; respond to, log and track deficiencies; develop and monitor corrective action plans.
• Serve as the Health Plan’s Privacy Officer and Fraud Prevention Officer.
• Serve as the Health Plan’s contact for regulatory agency inquiries and issues; ensure that communication and responses are accurate and consistent.
• Oversee the identification, preparation, maintenance and monitoring of appropriate and required data, records, reports and other documentation; includes regulatory filings.
• Oversee the reviews and responses to requests and subpoenas for protected health information.
• Develop and conduct compliance and related training programs and activities for the Health Plan…