Description |
No matter what your job title, the work you do at Kaiser Permanente supports the health and well-being of the millions of men, women, and children who turn to us for care. That's because all of us-from our marketing/sales professionals, to our financial team members, to our RNs and physicians on the front line of care-are committed to providing the best possible care experience. With locations across the United States, we offer the opportunity to build a rewarding career in an environment that supports your success. Join us and put your beliefs into practice.
Compliance Consultant III-Medicaid Managed Care Compliance
Kaiser Permanente
Oakland, CA or Pasadena, CA or Portland, OR or Atlanta, GA or Rockville, MD or Denver, CO
Researches, plans, implements, and monitors a broad portfolio of compliance systems and initiatives to enable organizational compliance with Federal Medicaid regulations, in addition to supporting research for state and local Medicaid regulations/laws. As well as overseeing the protection of organizational assets. On an on-going basis, researches and interprets Medicaid Managed Care regulations and laws to establish compliance standards, and may develop and/or deliver training and communications/change management relative to new standards. Assesses organizational systems (both physical and process or data related) to determine gaps in compliance and determine opportunities for remediation. Advises the organization on all compliance matters. May investigate violations of compliance policy, laws, regulations, etc. or conduct on-going monitoring and reporting to ensure remediation. May be responsible for project management relative to new Medicaid compliance initiatives, products, or annual processes.
Essential Functions:
- Manages, creates, and maintains client relationships
- In adherence with the KP Compliance Framework, fosters comprehensive compliance management through a series of activities to comply with all applicable regulations and statutes. Activities include
- Planning: Identifying compliance accountabilities; identifying internal and external resources; developing Compliance, Work, and Audit plans; participating on and may establish compliance-related committees/work groups; and managing external agency relations,
- Implementing: Identifying compliance requirements and conducting related analyses; creating or revising compliance standards, policies, and procedures; developing and/or conducting compliance and ethics training; monitoring compliance adherence; and reporting on compliance efforts and programs, and
- Validating: Reviewing compliance programs and content, including designing and conducting risk assessments and/or audits, and investigating instances of reported non-compliance
- Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Communicates required changes, develops tools to assess risks, and leverages existing workgroups/etc. to facilitate required changes
- Works on assignment of diverse scope
- Generally performs within broadly defined practices and guidelines, and also modifies or suggests enhancements
- Requires planning to coordinate with other departments or resources
- Responsibilities impact the achievement of key department, functional, or stakeholder objectives
- Contributes to the achievement of department objectives
- Erroneous decisions or failure to achieve department objectives would normally affect expenditures and resources
- Involves interpreting and analyzing established concepts and trends
- Exercises judgment to make decisions for less defined issues and selects methods and techniques for obtaining solutions
- Requires moderately complex decision-making
- Develops solutions to complex problems. May refer to established precedents and policies
- Requires significant analysis to develop solutions for complex problems
- Provides professional/technical guidance to team members and stakeholders
- Communicates and influences acceptance and adherence to policies, practices, procedures of both an interpretive and non-interpretive nature
- Influences others regarding existing concepts, processes and/or methodology
- Assume other duties as directed
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Requirements |
Basic Qualifications:
- Required: Five (5) to eight (8) years of heath care compliance, health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience
- Must have Medicaid Managed Care experience
- Four (4) year or clinical degree or equivalent experience
- Thorough knowledge of health care compliance policies, practices and systems
- Complete understanding of compliance principles, theories, and concepts
- Full knowledge of health care industry practices and standards
- Ability to draft and revise documents including policies, standards, analyses, and reports
- Project management skills
- Thorough knowledge of health care and related compliance issue
Primary Location: California-Oakland
Scheduled Hours (1-40): 40
Shift: Day
Working Days: Mon - Fri
Working Hours Start: 8:00
Working Hours End: 5:00
Schedule: Full-time
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried Employees
Job Level: Individual Contributor
Job: Compliance / Privacy / Regulatory
Public Department Name: National Compliance Ethics & Integrity Office
Travel: Yes, 10% of the time
External hires must pass a background check/drug screen. We are proud to be an equal opportunity/affirmative action employer.
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