Director, Integrity

Director, Payment Integrity---------------------------------------------------------------This position is responsible for leading the execution of payment integrity strategy and activity across the organization. Time is focused on business group and vendor oversight, with secondary time on enterprise-wide engagement. Primary duties include operational planning and oversight, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization.
** Estimated Hiring Range:**$ - $
** Bonus Target:
** Bonus - SIP Target, 10% Annual Current Care Oregon Employees:
Please use the internal Workday site to submit an application for this job.

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** Essential Responsibilities
** Technical/Operational Leadership
* Direct operational payment integrity activities across the organization in support of all lines of business.  This includes post and pre-pay audit functions, payment recovery processes, COB, subrogation, medical record review, as well as fraud, waste and abuse clinical reviews.
* Lead the execution of strategic initiatives, plans, and goals in alignment with organizational vision and goals.
* Ensure payment integrity processes are in compliance with Federal and state regulatory and contractual requirements.
* Provide oversight and ensure updated policies and procedures are maintained across Operations.
* Design, implement, and oversee a robust operations and vendor quality review audit program to meet corporate and strategic goals; present audit results to include root cause, trend analysis and prepare remediation recommendations on a regularly scheduled basis; monitor remediation activities for effectiveness.
* Ensure payment integrity productivity, financial and quality targets are established, measured, and reported.
* Establish business cadence (weekly, monthly, quarterly business reviews) to ensure results are met and/or exceeded.
* Prepare and present on the progress of Payment Integrity capability-building.
* Effectively use business intelligence and data analytics to monitor operations and identify cross functional process improvement opportunities.
* Instill work culture of continuous process improvement, innovation, and quality.
* Oversee the development and implementation of cross-functional operations improvements including standardization and controls design to ensure planned results are delivered.
* May serve as a sponsor or chair for key projects and initiatives involving Payment Integrity.
* Oversee Payment Integrity projects and implementation.
* Oversee multiple Payment Integrity vendor relationship(s) and performance, including enrollment premium vendors.
* Identify cost effective technologies, workflows and sourcing partnerships necessary to meet strategic commitments.
* Develop payment integrity inventory tracking and staff forecasting tools.
* Oversee payment integrity vendor performance, as well as vet new payment integrity vendor offerings/expansions.

Strategic/Operational Planning
* Participate in the development of vision, goals, and strategic plans for Payment Integrity.
* Develop short- and long-term plans and policies; oversee the development and execution of standard operating procedures.
* Provide input into the strategic plans of the organization.
* Maintain a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management
* Recommend budgets in alignment with short- and long-term plans.
* Manage resources to ensure priorities are accomplished.
* Approve resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.
* Develop comprehensive business case for budget variance requests to include ROI analysis; ensure approval for budget variances as required.

Relationship Management
* Lead effective communication system for work group(s), ensuring a collaborative culture.
* Build and ensure effective relationships across internal teams and external organizations for current or future integration.
* Work cross-functionality with internal and external stakeholders in identifying and driving projects, process improvement initiatives, and operational efficiencies.
* Work closely with senior leadership, peers, and cross-department leadership providing programmatic, organizational, and technical support to ensure effective collaboration and integration of Payment Integrity functions.
* Represent Care Oregon in external meetings and functions, providing productive leadership presence and effectiveness.
* Lead weekly, monthly and quarterly business review meetings with vendors and executive management as appropriate.

Employee Supervision
* Direct team(s) and establish team direction and goals in alignment with the organizational mission, vision, and values.
* Identify work and staffing models; recruit, hire, and oversee a team to meet work needs, using an…