Director Compliance (4701BR) Troy, Michigan

Job Summary

Day-to-day responsibility for implementation of the Compliance Plan.  Functions as an objective body that reviews, promotes and evaluates compliance issues/concerns for Molina Healthcare. Ensures management and employees of Molina achieve consistently high levels of compliance with all laws and regulations while supporting the growth of the organization

Essential Functions

• Establishes audit controls and measurements to ensure correct processes are established.  Develops and performs internal audits/risk assessments, monitoring program for Molina Healthcare departments.  Provides post audit findings and recommendations to ensure contractual State and Federal Compliance.
• Coordinates development of written policies and procedures regarding compliance with local, state and federal guidelines.
• Selects and directs the Compliance Committee.
• Facilitates delivery of specialized education and training concerning compliance responsibilities.
• Develops and implements Anti-Fraud program.
• Establishes active relationships with third parties who have specific experience conducting fraud investigations.
• Responds to inquiries and reporting concerning compliance or non-compliance.
• Assists management with enforcement and discipline in appropriate instances of non-compliance.
• Regularly informs Board of Directors of the status of and activities pertaining to compliance.
• Reports upon discovery incidents and issues of non-compliance related to HIPAA to the Privacy Official within 24 hours.
• Submits all PHI requests to Privacy Official for approval/processing.
• Works with all business segments of Molina to increase awareness of the importance of Compliance and Anti-Fraud plans.
• As a representative of key management, enforces in its day-to-day responsibilities of the Compliance Plan, Code of Conduct and Anti-Fraud Plan.
• Provides leadership for the compliance function and serves as a resource to departments and health plans on compliance issues, including budgeting for activities related to implementation of the Compliance Plan.
 
State Plan / Department Specific Duties and Responsibilities

• Reports regularly, but not less than quarterly, to the Board of Directors.  For administrative and day-to-day operating responsibilities, takes direction from the Plan CEO.  For purposes of performance assessment and compliance related activity, the Compliance Director will report to the MHI Vice President of Compliance. 

Knowledge/Skills/Abilities

• Ability to effectively present information and respond to inquiries from employees, regulatory agencies, and others, as necessary
• Credible leadership presence skills
• Ability to respond to questions with logic, clarity, calmness and authority which leads to desired support of actions by others
• Adept at handling complex project planning management issues including the ability to effectively delegate tasks
• Strong team building, problem solving and analytic skills including problem identification, analysis, and resolution
• Ability to read, analyze, and interpret governmental regulations and legal documents.
• Ability to manage large projects with multiple stakeholders.
• Ability to develop, organize, and implement policies & procedure
• Computer proficiency with Microsoft Office products
• Excellent verbal and written communication skills
• Excellent interpersonal skills, ability to facilitate teams and resolve conflict effectively
• Ability to develop, organize and implement procedures
• Ability to work independently and set priorities
• Ability to abide by Molina’s policies
• Ability to maintain attendance to support required quality and quantity of work
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and  customers



Required Education: 
Bachelor’s Degree                                                                                                  
Required Experience:     
• 5 years plus previous compliance program and contract experience with Medicaid/Medicare programs including conduct of internal and state audits.
• 5 years plus experience with health care regulatory agencies in development or implementing of compliance and fraud programs.
• 5 years plus experience with overseeing implementation of contract requirements.
• Representation to the Board and senior management on health plan issues relating to compliance and fraud program management.  
                                                                                                              Required Licensure/Certification:
None
Preferred Education:
Master’s Degree   
Preferred Experience:
         
Preferred Licensure/Certification:
None       



To all current Molina employees if you are interested in applying for this position please apply through the intranet job listing. Also, fill out an Employee Transfer Request Form (ETR) and attach it to your profile when applying online.

Molina Healthcare offers competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

To apply, please click here