Health Share of Oregon

The position oversees the development, execution, and oversight of all Health Share contracts with particular emphasis on the contract with the Oregon Health Authority and delegation agreements with Health Share subcontractors.. Develop, execute and oversee a compliance plan which includes risk assessment and monitoring of internal activities related to execution of the Health Plan Services Contract with the Oregon Health Authority.. Provide oversight and direct staff in implementing processes for delegation and quality oversight including care and utilization management, quality assurance, performance improvement, and program integrity.. Minimum 8 years' experience in related work, including 4 years' experience in Medicaid/Medicare compliance and quality assurance experience. Health Share is committed to creating a diverse staff made of people who are dedicated, optimistic and committed to health equity from all segments of the greater Portland Region, and we encourage people of color, people with disabilities, LGBTQ+ people, women and nonbinary people, and Veterans to apply for consideration.

director compliance

Career Opportunities: Director, Compliance and Quality Oversight (24168) Requisition ID 24168 - Posted 03/20/2024 - Health Share of Oregon - Full Time - Permanent - Portland - Multi Location (2) Job Title Director, Compliance and Quality Oversight Exemption Status Exempt Department Delegation and Quality Oversight Manager Title Chief Operations Officer Direct Reports DQO Manager, Contract Administrator Requisition # 24168 Pay and Benefits Estimated hiring range $135,198 - $165,242 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This positon is a hybrid role, predominately remote with occastion in-person meetings at the HealthShare of Oregon office. Job Summary The Director of Compliance, Delegation and Quality Oversight oversees all compliance, delegation and quality oversight activities of the company to ensure Health Share and delegated entities are compliant with federal and state regulations and contractual obligations related to the Oregon Health Plan Medicaid program. The position oversees the development, execution, and oversight of all Health Share contracts with particular emphasis on the contract with the Oregon Health Authority and delegation agreements with Health Share subcontractors. This position serves as the Compliance Officer for Health Share. Essential Responsibilities Compliance Develop, execute and oversee a compliance plan which includes risk assessment and monitoring of internal activities related to execution of the Health Plan Services Contract with the Oregon Health Authority. Identify and evaluate risk factors relative to Health Share's compliance and program integrity obligations; identify potential areas of compliance vulnerability and ensure corrective action to reduce or mitigate these risks. Identify and evaluate potential risk factors in delegating regulated functions; ensure corrective action to reduce or mitigate these risks. Develop, implement and oversee program integrity functions, including prevention and detection of fraud, waste and abuse; respond promptly to potential instances of fraud or abuse, reporting to appropriate state and federal agencies. Develop and implement company training and education program related to program integrity and compliance. Effectively collaborate with the Privacy and Security Officer on compliance related issues. Delegation and Quality Oversight Lead quality assurance strategies and planning; oversee implementation and effectiveness. Participate in the development and oversight of cross-functional initiatives with accountability for components related to quality of care, grievance system, and program integrity. Develop, update and revise policies and procedures related to areas of accountability. Provide oversight and direct staff in implementing processes for delegation and quality oversight including care and utilization management, quality assurance, performance improvement, and program integrity. Organizational Responsibilities Perform work in alignment with the organization's mission, vision, and values. Support the organization's commitment to equity, diversity, and inclusion by fostering a culture of open mindedness, cultural awareness, compassion, and respect for all individuals. Strive to meet annual business goals in support the organization's strategic goals. Adhere to the organization's policies, procedures, and other relevant compliance needs. Perform other duties as needed. Knowledge, Skills and Abilities Required Knowledge: Advanced knowledge of Federal and State regulations related to Medicaid and ability to interpret and communicate these requirements Advanced knowledge of principles, practices, procedures and professional standards associated with compliance and quality assurance program management and techniques for evaluation of program effectiveness Extensive knowledge of managed care and the Oregon Health Plan Ability to obtain and retain knowledge of government regulations as they relate to the administration of OHP and Medicare the principles and practices of coordinated care health plan benefits, systems and procedures, changes in guidelines and regulations, changes in the health care services, changes in the legal/legislative arena that impact operations health care public policy issues Core Skills and Abilities: Ability to provide effective leadership and direction of staff and delegate appropriate activities Budget management skills, as well as ability to monitor and address cost effectiveness Excellent verbal and written communication skills, including the ability to persuade, influence, negotiate and make formal presentations Ability to analyze and solve problems, prioritize, organize and manage multiple tasks Adept at utilizing various approaches to achieve consensus, achieve favorable outcomes, manage change and influence others Ability to work effectively with diverse internal and external stakeholders Ability to oversee or manage multiple complex projects concurrently, ensuring effective use of resources and achievement of outcomes Physical Skills and Abilities: Ability to perform repetitive finger, wrist, shoulder, or neck movement for at least 8 hours/day Ability to see, read, hear, and speak clearly for at least 8 hours/day Cognitive Skills and Abilities: Ability to focus on and comprehend information and learn new skills and abilities Ability to assess a situation and seek or determine appropriate resolution Ability to accept direction and feedback, as well as tolerate and manage stress Education and/or Experience Required: Minimum 8 years' experience in related work, including 4 years' experience in Medicaid/Medicare compliance and quality assurance experience Minimum 4 years' experience in a supervisory position Preferred: Compliance and quality assurance experience in a managed care setting Working Conditions Primary Work Environment: Indoor/Office Member Facing Patient Facing Facilities/Security Other Work Environment(s): Indoor/Office Member Facing Patient Facing Facilities/Security Outdoor Exposure Hazards: n/a Equipment: General office equipment Travel: This position may include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used. #Li-Hybrid Health Share is an equal opportunity employer and employs personnel without regard to age, citizenship, color, creed, physical or mental disability, economic status, education, ethnicity, family responsibilities, gender identity and expression, genetic information, health status including HIV status, height, housing status, marital status, matriculation, national origin, physical appearance, race, religion, political affiliation, pregnancy, sex, sexual orientation, union membership, veteran status or other unlawful factors, with respect to recruiting, hiring, job assignment, promotion, discipline, discharge, compensation, training and other terms, conditions and privileges of employment and contracting. Health Share is committed to creating a diverse staff made of people who are dedicated, optimistic and committed to health equity from all segments of the greater Portland Region, and we encourage people of color, people with disabilities, LGBTQ+ people, women and nonbinary people, and Veterans to apply for consideration. Visa sponsorship is not available at this time. Email this job to a friend The job has been sent to Job title: * Your friend's email address: Message:
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