Vice President, Health Plan Compliance & Regulatory Affairs

Overview

Oversees the development, implementation, and management of compliance activities and enforcement for all VNS Health Health Plans insurance plans and products (e.g., managed Medicaid (i.e., mainstream, HIV SNP, Partial Cap/MLTC) and Medicare Advantage (i.e., MA-PD, D-SNP, FIDE SNP) products) in accordance with NYS DOH and CMS requirements, including review and evaluation of compliance issues/concerns within the organization. Ensures that company policies and procedures are developed and implemented in accordance with regulatory standards, and that behavior in the organization meets the company's Standards of Conduct and protects the rights of members and consumers of the Plans products and services.

Oversees and ensures consumer protections afforded to members of VNS Health and new and existing VNS Health products, initiatives and processes are planned and implemented consistent with CMS and NYS regulations and agency policies and procedures. Works with VNS Health Compliance team and adheres to VNS Health compliance policies and procedures. Works under limited direction.

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

• Participates in the development of long- and short-term strategic goals for VNS Health Health Plans, consistent with overall VNS Health objectives and ensures compliance with all federal and applicable state laws and regulations related to the governance of Medicare Advantage Organizations (MAO) and NYS Medicaid Health Insurance Plans.
• Gathers internal and external information regarding current industry practices and trends to develop and maintain VNS Health compliance plan. Ensures effective implementation of the VNS Health Compliance Program. Creates an annual work plan to be used as a guideline throughout the program to ensure compliance with regulatory requirements.
• Oversees audits and monitoring activities of internal operations and external vendors consistent with the work plan. Collaborates with Operational leadership, Quality, Human Resources, Legal, and others as appropriate, to implement audits and corrective action plans, as needed.
• Ensures consistency in the application of disciplinary actions related to violations and incidence of non-compliance.
• Collaborates with Education department to ensure all VNS Health Health Plans staff have the appropriate tools and training necessary to adhere to the VNS Health Compliance Programs.
• Educates staff to ensure the prevention of illegal, unethical or improper conduct that places consumers or the Health Plan at risk.
• Develops and coordinates staff training on topics related to regulatory compliance and Fraud, Waste and Abuse. Monitors and oversees compliance for First‑Tier, Downstream and Related Entities, including creation and application of training, education and communication requirements and producing proof/attestations to show compliance thereof.
• Ensures timely responses all compliance‑related reports and inquiries received through internal and external sources including compliance hotline.
• Acts as point person and liaison for staff at CMS and DOH who provide oversight of VNS Health programs. Submits and obtains DOH and/or CMS approvals for new/revised policies, procedures, subcontracts, letters, notices, and marketing materials, as necessary. Reviews and evaluates new regulations and practices to ensure that internal policies are consistent with Federal and state regulations. Serves as subject matter expert to program and related corporations.
• Acts as resource for VNS Health staff regarding the CMS and state regulations, contracts, and policies that govern VNS Health…