Job Summary

As Compliance Officer, serve as Vivant Health’s (Vivant) Compliance and Privacy Officer and manage and direct all aspects of Vivant’s Compliance and Privacy Program, work to enhance existing compliance programming, and implement new policies and procedures as appropriate to ensure that the Vivant governing body, management and employees achieve consistently high levels of compliance with applicable laws, regulations, contractual obligations policies, and standards. As Legal Counsel, work with Vivant General Counsel (“GC”) on a variety of legal, regulatory, transactional, contract, managed care, business, operational, employment, and healthcare matters.

Responsibilities

Compliance:

Establish and maintain an effective, comprehensive Compliance and Privacy Program.
Develop, initiate, maintain and revise policies, procedures and practices to prevent, detect and respond appropriately to potentially non-compliant practices, including Privacy and Fraud, Waste and Abuse practices.
Direct and supervise Department employee(s) to achieve the desired outcomes.
Monitor, coordinate and track Vivant’s day-to-day compliance activities.
Collaborate with other Vivant departments to direct compliance matters to appropriate channels for investigation and resolution.
Consult with, and work collaboratively with, Vivant’s General Counsel and outside counsel to address legal compliance issues.
Respond effectively to potential violations of applicable standards and develop and oversee a uniform system for documenting and resolving them.
Develop and implement compliance and audit work plans.
Oversee all company audits.
Manage Corrective Active Plans.
Oversee Vivant’s Compliance Hotline.
Institute and maintain effective compliance communications.
Ensure compliance training is current and appropriate.
Report to management and the governing body about compliance initiatives, activities and developments.
Act as Vivant’s HIPAA Privacy Officer.

Legal

Support Vivant’s GC in legal, compliance, regulatory, transactional, contract, managed care, and other healthcare, business, operational, and employment matters
Support the GC in the performance of the legal function, including the provision of broad based legal, strategic, and regulatory advice and services.
Review, draft, negotiate, and provide oversight on a variety of healthcare and business transactions and contracts.
Support the GC in the management of any disputed matters, record requests, and subpoena responses.
Maintain excellent working relationships and work collaboratively with Vivant’s management and leadership.
Manage, organize and perform a variety of activities simultaneously while maintaining accurate and complete records and files.
Assist management personnel in obtaining clarification and/or additional information on statutory, regulatory and contractual requirements, as necessary. Competencies

Competencies

5+ years of experience in a healthcare compliance leadership role at a Medi-Cal managed care focused Independent Physician Association (IPA), medical group, or health plan is strongly preferred.
2+ years of experience acting as legal counsel within the past 7 years is preferred. Current expertise in Medi-Cal and DMHC/DHCS is required. Additional expertise in Medicare Advantage is preferred.
Demonstrated knowledge and experience working for or with Medi-Cal managed care organizations is strongly preferred, including medical groups, IPAs, health plans, Management Services Organizations (MSOs), Department of Managed Health Care (DMHC), and other healthcare systems and managed care organizations.
Demonstrated knowledge and experience working with HIPAA privacy, corporate compliance programs, and healthcare industry laws and regulations is required.
Demonstrated track record of serving in increasingly responsible compliance positions and working collaboratively and effectively with others.
Furtherance of the organization’s strategic objectives, and development of creative and thoughtful solutions, taking into account the current legal and regulatory landscape, the organization’s policies and procedures, and its current and future needs.
Strong communication and leadership skills, including diplomacy, independence, integrity, and trustworthiness, while commanding respect of the senior management and executive team, governing body and other colleagues.
Possess the demeanor, maturity, skill, discretion and professionalism to work and interact effectively with multiple and diverse constituencies who may be internal or external to Vivant, its subsidiaries, and affiliates.
Consistently exercise sound judgment, and strict maintenance of confidentiality.
Proactively and effectively solve problems.
Collaboration with others, and development of partnerships and good working relationships.
Excellent legal research, writing, analytical, and communication skills.
Excellent attention to detail, multi-tasking, time management, project management, and organization skills. Microsoft software (Word, Excel, PowerPoint) expertise.

Education And Licensure

Juris Doctor degree required.
Certification Health Care Compliance (CHC) highly preferred.

Travel

The incumbent may travel up to 5% of the time.

Work Environment

This job operates in a professional office environment. This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.

Mental And Physical Demands

Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the position. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing this job, the employee is regularly required to talk and hear. The employee frequently is required to sit, stand; walk; use hands to finger, handle, or feel; and reach with hand and arms. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. Experiences frequent interruptions; required to meet inflexible deadlines; requires concentration and attention to detail; requires a high level of organizational and prioritization skills. May be required to sit for prolonged periods; exposed to visual display terminal for prolonged periods; dexterity and precision required in the operation of a computer.

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COMPLIANCE OFFICER AND LEGAL COUNSEL