Risk & Compliance Officer enhancing governance for financial compliance at LYNX. Collaborating with stakeholders and managing risk frameworks in Amsterdam.
HI
Onsite Director of Compliance – Contract Management
Posted 12 hours ago
About the role
- Director of Compliance and Contract Management providing strategic leadership and operational oversight for PACE. Ensuring adherence to regulatory compliance and contract management for Elder Service Plan.
Responsibilities
- Provides strategic leadership and operational oversight for all regulatory compliance and contract management, for the Program of All-Inclusive Care for the Elderly (PACE)
- Ensures adherence to federal and state PACE regulations (CMS and state Medicaid agency requirements)
- Manages critical payer contracts, and maintains the organization's compliance infrastructure
- Develops, implements, and maintains comprehensive compliance programs that meet all CMS PACE requirements (42 CFR Part 460) and state Medicaid regulations
- Monitors and interprets changes to PACE regulations and implement necessary programmatic adjustments
- Maintains all compliance documentation, policies, and procedures in accordance with PACE requirements
- Oversees completion and submission of required regulatory reports and data submissions
- Negotiates, executes, and manages all PACE-related contracts
- Oversees vendor contracts, provider network agreements, and business associate agreements
- Monitors contract performance, ensures compliance with contractual obligations, and identifies areas for contract optimization through routine contractor audits
- Conducts regular compliance audits and risk assessments across all PACE operations
- Investigates compliance concerns, incidents, and potential violations; implements corrective action plans
- Develops and delivers compliance training programs for staff, providers, and leadership
- Works collaboratively with Harbor Health’s Vice President of Compliance and Risk Management to ensure PACE regulatory requirements align with enterprise-wide compliance standards
- Collaborates with interdisciplinary team members, including clinical leadership, finance, operations, and IT
- Participates in leadership meetings and strategic planning initiatives
- Serves on Harbor Health’s Compliance Committee and other organizational committees as assigned
- Fosters culture of compliance and ethical conduct throughout the organization
Requirements
- Bachelor’s degree in a related field required
- Masters Degree in Health Care Administration or equivalent desired
- Minimum of 5-7 years of progressive experience in healthcare compliance, regulatory affairs, or contract management
- Minimum of 3 years of experience with PACE programs or similar managed care/integrated delivery systems required
- Experience with CMS regulations, Medicare/Medicaid contracting, and value-based care models
- Demonstrated success managing regulatory surveys and audit processes
- Knowledge of the needs of aging populations and the healthcare services required to support them
- Demonstrated leadership and management capabilities to facilitate effective and efficient operations and support effective relationships with external agencies and organizations
- Ability to observe, analyze and interpret general, technical and clinical data (verbal and written)
- Excellent communication skills
- Ability to effectively prioritize responsibilities while under pressure to meet deadlines, strong attention to detail and highly organized
- Ability to operate as a team leader and work collaboratively with others
- Able to work with diverse populations
- Intermediate skills in Microsoft Office 365 including Word, Excel, Outlook and Teams.
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