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Job Details

Director of Corporate Compliance and Privacy

Job Ref: 56744
Category: Professional
Location: 160 Water St. #3, New York, NY
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $110,000.00
Salary Range: $110,000.00 - $125,000.00

Marketing Statement

MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. 

Position Overview

The Director of Corporate Compliance and Privacy reports to the Senior Director of Compliance Operations and is responsible for assisting in the implementation and management of the Corporate Compliance, Vendor Compliance and Privacy Programs. This individual oversees daily operational and functional requirements of these programs and in addition to leading activities related to fraud, waste and abuse detection, investigation, and prevention.

Job Description

  • Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives. Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance.
  • Coordinating compliance and monitoring activities of throughout the organization to remain abreast of the status of all compliance activities and to identify trends.
  • Identifying areas of potential vulnerability and risk, developing corrective action plans, and providing  general guidance to address issues.
  • Develops and/or ensures that internal controls are implemented to prevent and detect instances or patterns of illegal, unethical, or improper conduct.
  • Overseeing all activities related to Vendor Compliance, including managing the MetroPlus program to audit and monitor delegated vendors and business associates.
  • Serving as participating member of the Vendor Delegation Oversight Committee and Compliance Committee representing Corporate Compliance, Privacy, and FWA concerns.
  • Leads response efforts for regulatory filings, audits, and other oversight activities by regulators.
  • Oversees the privacy investigation process, including logging and tracking privacy related complaints/incidents, preparing final investitive findings, and preparing/submitting any related reports to regulatory agencies. Also, responsible for notifying individuals in cases of a breach.
  • Monitor key elements of the Corporate Compliance, Vendor Compliance, and Privacy Programs.
  • Develop supporting materials for presentations, policies, and reports on the progress of initiatives and accomplishments for all areas under their responsibility.
  • Keeping up to date on the latest developments and federal and state laws and regulations.
  • Assisting with development and implementation of training programs for members of the workforce addressing Compliance, Privacy, and FWA.
  • Establishes and provides direction and management of the Compliance Hotline.
  • Provides direct management of the Corporate Compliance Analyst and Vendor Compliance Analyst.
  • Other activities as assigned by the Senior Director or Chief Legal and Compliance Officer.

Minimum Qualifications

  • Bachelor’s degree in a health-related field.
  • Minimum of 7 years of experience in healthcare compliance.
  • Preferred candidate will possess:
  • Master’s degree in business/public administration or public health
  • Health insurance plan and/or health care industry work experience
  • Knowledge of Medicaid, Medicare, Affordable Care Act, and HIPAA
  • Knowledge and experience in information privacy laws; access and release of information; FWA
  • standards; and principles of change management
  • Excellent analytical, organization, and oral and written communication skills
  • Expertise with Microsoft Office Suite

Licensure and/or Certification Required

  • CHC, CHPC, and/or CCEP

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles. The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
  • Experience with managed care, Medicare and federal and/or state regulations, quality improvement and compliance oversight.
  • High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
  • Simultaneously manage multiple projects.
  • Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences
  • The utmost integrity in the discreet and confidential handling of confidential materials is necessary
  • Demonstrated knowledge of managing and building relationships with stakeholders, including senior management, with strong influencing and negotiation skills.
  • Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team.
  • Sound working knowledge of Windows-based software packages, including Word, Excel, PowerPoint SharePoint, and Visio as well as online/Internet-based research tools.