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VP Corporate Compliance Officer

at CareSource

Posted: 9/23/2019
Job Reference #: *D40B11BAC3415AA7

Job Description

Requisition Number

Post Date

VP Corporate Compliance Officer




Role & Responsibility

· Assist the organization in achieving responsible and effective corporate (risk management) and compliance programs

· Formulates an organization-wide integrated and holistic approach to governance, risk and compliance including strategy, processes, technology and people

· Proactively identify major risk events

· Perform risk assessments and compliance investigations

· Coordinates Ethics & Compliance hotline

· Monitors key compliance risk areas and may engage outside services for compliance audits

· Ensure that improvement opportunities and problems identified through auditing and monitoring have been addressed through effective follow up mechanisms including management accountability and remedial action

· Maintain current knowledge of laws and regulations

· Establish policies and procedures to maintain compliance

· Educate on compliance program, policies & procedures and communicate awareness

· Monitor compliance with laws, regulations, policies and procedures

· Responds to all concerns reported to compliance functions and hotline

· Recruit and develop key staff

· Serves as Chair, Compliance Committee and Vice Chair, ERM Committee

· Serves as HIPAA Privacy Officer

· Ensure effective staff compliance training program

· Responsible for CIA, IRO, OIG, investigations hotline and training (including 7 elements)

  • Perform any other job related instructions as requested, with reasonable accommodation

Key Decision Rights

· Development of compliance policies and procedures

· Annual risk and compliance plan

· Hiring of Staff

  • Conduct and authorize investigations, in conjunction with Legal

Cross Functional Interactions

· Interact with internal departments, such as Government Affairs, Legal, IT, Finance, Quality, EPM, Markets


· Perform duties as established in Board approved program or charter

· Effectiveness and efficiency of operations

· Reliability of financial reporting

· Compliance with applicable laws and regulations

· Ensures auditing and monitoring of key compliance risk area

· Provides necessary compliance controls relative to IT system implementations and controls

· Ensures proper HIPAA privacy and security controls

  • Ethically correct behavior, improved efficiency, improve effectiveness thru insuring operations is managed and supported through the GRC

Working Conditions

  • General office environment


Education / Experience

· Bachelor of science degree in business administration, healthcare administration or related discipline is or equivalent work experience is required

  • Master’s in Business Administration, Healthcare Administration and/or other related discipline is preferred
  • Seven or more years of compliance or related experience is required
  • Senior Executive Leadership experience with a managed care organization or related industry

Required Competencies / Knowledge / Skills

· Strong working knowledge of compliance theory, practices, laws, regulations, guidelines and professional standards

· Depth in governmental product design and experience working with underserved populations

· Understanding of Medicare/Medicaid regulatory requirements

· Strong understanding of healthcare finances

· Knowledgeable of HCCA, AHIA, COSO

· Commitment to the mission and values of the CareSource Family of Companies

· Strong collaborative skills, working with cross-functional stakeholders and external partners including state and federal regulators

· Effective communication and presentation skills

Licensure / Certifications

  • Certified in Health Care Compliance (CHC) is preferred

The statements contained herein describe the essential functions of this position. This description isnot an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, subject to reasonable accommodation.