Job Summary:
This senior level individual contributor is primarily responsible for conducting local or market compliance activities across multiple disciplines in partnership with internal and external stakeholders and driving compliance field operations. Responsibilities include leading compliance reporting efforts and compliance investigations across multiple business functions. Additional key responsibilities include managing programs or compliance components of larger cross-functional programs and driving activities associated with continued regulatory compliance for multiple business functions by monitoring, interpreting, and designing strategy around regulatory changes. This senior level individual contributor also drives the implementation of compliance efforts by identifying compliance requirements and leads the assessment of current state compliance to identify gaps and corrective actions.
Essential Responsibilities:
- Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and improve opportunity areas; and adapting to and learning from change, difficulties, and feedback.
- Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks, as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; evaluating recommendations made; and influencing the completion of project tasks by others.
- Conducts local or market compliance activities across multiple disciplines and designated medical centers, ambulatory surgery centers, and/or hospitals by ensuring team members, including external business partners, provide support to internal and external stakeholders, including members; driving compliance field operations and the resolution of critical issues on a 24/7 basis; designing strategies for the implementation of regulations and regulatory changes; ensuring compliance activities are fully documented; researching and keeping abreast of current compliance requirements, regulations, and policies; acting as an end-to-end partner to business line stakeholders.
- Leads compliance reporting efforts across multiple business functions by evaluating and summarizing compliance data, audit information, and potential risks and remedies; identifying and reporting key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations) to management; and developing presentations to convey key findings to management and other key stakeholders.
- Leads compliance investigations across multiple business functions by coordinating the collection and analysis of quantitative and qualitative data; leading interviews as appropriate; researching key business issues; and evaluating and recommending corrective action plans for substantiated allegations.
- Manages programs or compliance components of larger cross-functional programs by identifying and managing stakeholder contacts; assembling teams based on program needs and team member strengths; developing, analyzing, and managing program plans; and negotiating and managing program schedules and resource forecasts.
- Drives activities associated with continued regulatory compliance for multiple business functions by monitoring, interpreting, and designing strategy around regulatory changes; determining the impact of changes to the business; providing direction on implementation of changes throughout the business; and providing regulatory input before and during inspections to minimize the risks of future non-compliance.
- Drives the implementation of compliance efforts by identifying compliance requirements; leading the assessment of current state compliance to identify gaps and corrective actions; creating or revising complex compliance standards, policies and procedures, and training; and monitoring of ongoing compliance adherence.
Minimum Qualifications:
- Minimum three (3) years experience in a leadership role with or without direct reports.
- Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum eight (8) years experience in health care compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement. Masters degree (or higher) may serve as a substitute for a portion of the experience requirement.
Preferred Qualifications:
- Four (4) years experience working cross-functionally across departments, functions, or business lines.
- Four (4) years health care experience.
- One (1) year program management experience.
- Four (4) years pharmacy experience to include pharmacy compliance, practice assessment, or regulatory affairs.
- Four (4) years experience working in a clinical setting (e.g., hospital, medical center).
- Two (2) years medical coding experience.
- Four (4) years law enforcement experience.
- Four (4) years experience working on fraud or white collar investigations.
- Four (4) years experience in health plan operations.
- Four (4) years experience in health plan compliance.
- Four (4) years experience in privacy and security compliance.
- JD degree.
- Clinical Bachelors degree.
- Masters degree in Health Care Administration, Clinical, Law, Public Health, Business or related field.
- Certified in Healthcare Compliance (CHC) or other equivalent compliance certification.
- Privacy & Security Compliance certification.
- Certification Professional Coder (CPC) certification.
- Registered Health Information Technician (RHIT) certification.
- Registered Health Information Administrator (RHIA) certification.
- Certified Public Accountant (CPA)
PrimaryLocation : California,San Leandro,San Leandro 2401 Merced St
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:01 AM
WorkingHoursEnd : 05:01 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-NCAL-09|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Compliance, Privacy & Regulatory
Department : Oakland Reg - 1950 Franklin - Regional Compliance - 0201
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.