VP, Compliance Officer

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

We offer Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We’re also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Jefferson Health Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing 
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off 
• Impact on the communities we service 

• Government liaison with regulatory agencies for the day-to-day management of contractual and operational issues related to all LOBs
• JHP’s compliance monitoring initiatives (all LOBs-internal and delegated vendors)
• Day-to-day operational issues (all LOBs)
• Compliance risk assessment and management function. 
• Regulatory and sub-regulatory research and policy initiatives and oversight.
• State and Federal reporting requirements
• Oversight and management of JHP’s Dual Special Needs Plan (DSNP) State Medicaid Agency Contract
• Compliance reporting channels (all LOBs)
• Audit and corrective action (all LOBs)
• Supporting various enterprise strategic initiatives 
• Implementation/ ongoing oversight of the organizational Compliance Program across all LOBs
•  Attend executive management meetings to represent Compliance
• Lead compliance investigations (all LOBs) and disclosures to any applicable regulatory bodies and executive leadership/ Board of Directors, as necessary

• Able to work in a constant state of alertness and safe manner.
• Oversee and monitor the implementation of the Compliance Program.
• Proactively identify process gaps, weaknesses, deficiencies, or business productivity/efficiency opportunities.
•  Create and implement tools (surveys, dashboards, etc.) and utilize resources that enable an ongoing review of existing and new risk areas for all lines of business.
• Establish and manage an ongoing catalog of risks (regulatory, sub-regulatory, compliance, etc.), prioritization mechanisms, and a means of handling risks in collaboration with other relevant departments, as needed. 
• Oversee the regulatory and sub-regulatory guidance distribution, tracking, and reporting process.
• Oversee the coordination and implementation efforts of new regulatory and contractual requirements impacting JHP.
• Administer and oversee JHP’s internal and delegated vendor compliance oversight program.
• Support strategic positioning of JHP concerning federal/state compliance and participate in strategic planning initiatives.
• Report regularly to the Chief Executive Officer (CEO), the Compliance Committee, and the Board of Directors’ Audit Committee on the progress of implementation and operation of the Compliance Program.
• Coordinate with senior management on all issues affecting compliance.   
•  Chair the Compliance Committee. 
• Manage and coordinate interactions with state or federal agencies, including responding to and documenting all responses to any agency requests.
• Implement and oversee all facets of the Compliance Program by defining the Program structure, educational requirements, reporting and complaint mechanisms, response and correction procedures, auditing and monitoring strategy, and compliance expectations of all personnel and vendors supporting all LOBs.
• Periodically revise the Compliance Program considering changes in JHP, statutes, rules, regulations, and requirements of federal, state, and private payer health care plans
• Develop, coordinate, and participate in a multifaceted educational and training program that focuses on the elements of the Compliance Program and seeks to ensure that all appropriate employees and management know and comply with pertinent federal and state health care program requirements.
• Oversee and manage an operational compliance function by working collaboratively with functional areas throughout the organization (e.g., Pharmacy, Medical Management, Finance, Clinical Programs, Enrollment, Member Relations, Claims, Sales, Marketing, Human Resources, Legal, etc.). 
• Lead and direct the compliance monitoring and audit strategy and corrective action plan process.
• Serve as a business partner/consultant with operational areas and assist in maintaining an understanding of and compliance with regulatory requirements and the organization’s internal policies and procedures.
•  Coordinate personnel issues with JHP’s Human Resources to ensure disciplinary standards are enforced consistently for compliance violations. 
•  Investigating, in conjunction with counsel as appropriate, and acting on matters related to compliance, including the flexibility to design and coordinate internal investigations (e.g., responding to reports of problems or suspected violations) and any resulting corrective action (e.g., making necessary improvements to JHP’s policies and procedures, taking appropriate disciplinary action, etc.) with all of the JHP departments, independent contractors, and health care professionals.
• Oversee the compliance processes related to providing day-to-day assistance to internal business units regarding regulatory/ operational compliance issues and concerns, including requests for information and clarification.  
• Develop policies and programs that encourage managers and employees to report actual or potential non-compliance, suspected fraud, and other improprieties without fear of retaliation.
• Maintain and foster a collaborative relationship with internal and external customers.
• Continue the momentum of the Compliance Program and the accomplishment of its objectives long after the initial years of implementation.
• Oversee the department’s budget to ensure we operate within budget constraints. 
• Perform other duties as assigned

Qualifications

• Bachelor’s degree required.
• Master’s Degree, Juris Doctor or equivalent graduate degree preferred.   

• 8-10 years’ experience in managed care and/or health care administration, insurance, or regulatory compliance with a minimum of 3 years in a management position required.

Skills, We Value:

• Proficient with Microsoft Excel, Access, and Word preferred.
• Excellent oral and written communication, time management, organizational   and interpersonal skills required.
•  Knowledge of regulatory and legislative process & familiarity with all health related regulatory and legislative requirements required.
• Capable of keeping up to date on all related regulatory and legislative developments required.
•  Understanding of compliance programs & impact on business units required.
•  Knowledge of managed care & broad understanding of Medicare, Medicaid, CHIP and ACA Marketplace; as well as other related health regulatory & legislative requirements required.
• Capable of identifying issues and synthesizing business implications for review and decisions making required.
• Strong attention to detail required.
• Ability to facilitate meetings and achieve consensus required.
• Ability to understand and interpret regulations and develop strategic communication plans for external parties required.
• Strong negotiations and conflict resolution skills required.
• Process and project management ability required.
• Experience developing and managing budgets required.