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Details
Posted: 18-Nov-23
Location: Irving, Texas
Salary: Open
Categories:
Operations
Internal Number: 16832000
Summary:
The Manager Health Plan & Networks Regulatory Affairs will collaborate with the Director of Health Plans Regulatory Affairs for CHRISTUS Health Plan and Networks (CHP) and all its lines of business. The Manager will be dedicated to the development, audit readiness and monitoring of the Health Plan's Compliance Program serving the needs of CHP. This role will report to the Director of Health Plans Regulatory Affairs. The Manager will collaborate with the CHP leadership team and the Corporate Compliance system team.
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Collaborates with the Director of Health Plans Compliance and the Director of Regulatory Health Plans Affairs in ensuring CHP & Networks remains compliant with state, federal and other regulatory entities in the implementation and operation of CHP & Network programs, as they relate to both state and federal government regulation and the U. S. Department of Health and Human Services (HHS).
- Manages the regulatory team to provide and track training for associates for HIPAA Privacy and compliance annual requirements for both Federal and State agencies.
- Manages the ongoing oversight of to meet CMS guidelines of the Compliance Program Effectiveness (CPE) Audit.
- Works with the regulatory team to monitor and submit the regulatory requirements of HMPS Part C and D reporting and external Data Validation Audit.
- Manages the regulatory team to ensure that regulatory deliverables are identified and submitted timely.
- Collaborates with both the system and CHP compliance teams monitor current requirements in relation to the organization's operations, as well as providing latest information for continuous standards of compliance.
- As directed by the Director of Regulatory Affairs will coordinate, monitor and/or present communication plan(s) to educate Associates in the organization on regulatory compliance requirements.
- Coordinates with Director of Health Plans Compliance and the Director of Health Plans Regulatory Affairs on new and revision of policies, procedures and practices that accurately reflect the most current regulatory requirements.
- Plans and rapidly adopts new and revised requirements. Collects, analyzes, and reports data in support of continuous compliance audit readiness activities.
- In collaboration with the Director of Health Plans Regulatory Affairs is responsible for the management of vendor activities and monitoring of CHPs Fraud and Abuse Plan and Compliance Work Plan.
- Directs audits to assess organizational compliance with regulatory requirements, coordinates risk assessment and manages the development of the work plan. Disseminates audit and surveillance results, as necessary and directs business unit leaders in the development of corrective action plans and reports results to Senior Leadership.
- Provide input (assist in the development) of the department budget.
- Provides guidance in the professional and technical development for team members.
- Conducts regularly scheduled meetings to communicate issues regarding on-going work issues, new developments, and overall effectiveness.
- Develops job competencies for staff members, conducts evaluations in a timely manner and ensures evaluations are fair and consistent and that performance expectations are communicated.
- Participates in the recruitment and retention of qualified staff members. Responsible for the appropriate orientation, development, and training of staff members.
- Performs conflict resolution, problem solving and initiates progressive disciplinary action when necessary.
- Develops and implements department policies and procedures as appropriate.
- Provides leadership in problem identification and inter / intra departmental coordination of problem resolution.
- Support an atmosphere of Total Quality Improvement within the department through its motivation, coaching and staff development and / or application and interpretation of department policies and procedures.
- Manages departmental regulatory affairs with regulations and statutes that govern the Health Plan.
- Provides continuous gap analysis; develops and manages project plans designed to identify, track and close gaps.
- Manages the collaboration and teamwork with business unit leaders, taking applicable federal and state laws and legislation (including House bills and Senate bills) and educating/supporting compliant operations.
- Serves as a back-up to Director of Regulatory Affairs.
- Performs other duties as assigned
Requirements:
- High School Diploma or General Education Development (GED) required
- Bachelor's degree OR four (4) years of experience in a directly related field require highly preferred
- Graduate degree preferred
- Excellent verbal and written communication skills.
- Highly organized, and able to prioritize tasks with little to no notice.
- Minimum six (6) years of process improvement, management consulting, change management, or related business experience
- Certified in Healthcare Compliance (CHC) Preferred
Work Type:
Full Time
EEO is the law - click below for more information:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf
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About CHRISTUS Health
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.
More Jobs from This Employer
https://careers.wedi.org/jobs/19423828/manager-health-plans-and-networks-regulatory-affairs
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