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VP, Chief Compliance & Risk Officer

JOB SUMMARY:
The Chief Risk & Compliance Officer (CRCO) is responsible for directing CommunityCare’s enterprise risk management (ERM) and compliance functions related to CommunityCare’s commercial plans (Employer Group Plans), and government programs (Medicare, and Affordable Care Act (ACA) Plans). The latter function ensures CommunityCare’s policies, procedures, practices, and systems (collectively, operations) meet regulatory compliance.

As the head of CommunityCare’s ERM program, the CRCO will leverage and mature existing or future risk management such as Internal Audit, Corporate Insurance and Reinsurance, Compliance, Strategic Project Management, Business Continuity, and other matters as necessary to achieve the strategic, financial, operational, regulatory compliance, and hazard management goals of CommunityCare.

In addition, the CRCO will institute effective data and cyber security risk management, conduct risk assessments, develop risk management and monitoring tools (risk heat maps, risk registers, risk dashboards, risk tolerance reports, risk appetite statements, risk modeling reports, risk-based capital reports, etc.) to provide insights on risks, support CommunityCare’s ongoing ERM efforts, and accomplish risk-reporting to CommunityCare’s Board of Directors.

Also, the CRCO will work with CommunityCare's operational departments to institute a culture of risk management designed to achieve CommunityCare's business strategies and goals across each CommunityCare department. Furthermore, the CRCO will file annually with regulators CommunityCare's Own Risk and Solvency Assessment (ORSA) Summary Report.

KEY RESPONSIBILITIES:
Direct the development and implementation of a sustainable risk management program. Responsible for leading the risk team, providing risk advice and consultation to management and risk staff, driving effective risk changes, and preserving a strong risk management culture. Develop and manage procedures, ensure appropriate training is provided to all staff for creating the basis for risk management decisions and controls across CommunityCare.
Ensure compliance with all state and federal regulatory and legal requirements; communicate regulatory requirements and policies related to CommunityCare's business to CommunityCare's Board of Directors, Management, and operational departments, as necessary, and to Compliance by such methods as written memorandum,presentations, and training meetings.
Serve as CommunityCare's Chief Compliance Officer, HIPAA Privacy Officer, and Medicare Compliance Officer; ensuring employees uphold HIPAA requirements, oversee HIPAA privacy-related compliance audits and responds to HIPAA privacy complaints.
Assist in auditing prospective business opportunities from a regulatory perspective; coordinate regulatory audits by government agencies; oversee development and review of plan benefits materials for consistency and compliance with regulatory requirements.
Oversee operations of CommunityCare's Government programs.
Improve the CommunityCare's strategic and legal regulatory position by working effectively with CommunityCare's Senior Management and agents; assist CommunityCare's Senior Management by performing special projects concerning CommunityCare's operational areas and attending committee meetings.
Directs the completion of special projects and reports as requested by CommunityCare's Senior Management.

QUALIFICATIONS:
Knowledge of and ability to apply advanced mathematical and statistical risk management principles and techniques.
Excellent knowledge of and advanced skills in using spreadsheet, Microsoft PowerPoint and Visio, and database applications.
Strong knowledge of and experience in the operationalizing appropriate risk management frameworks (COSO, ISO 31000, NIST, and hyprids) and processes.
Ability to analyze legal/regulatory information and communicate to management or outside counsel.
Proficiency in the use of work processing and computerized legal research applications.
Ability to perform research on the Internet.
Ability to articulate opinions orally and in writing in a clear and concise manner.
Ability to manage people and coordinate multiple work assignments and special projects to meet applicable deadlines.
Ability to project a positive corporate and personal image to public.
Ability to speak and write fluently in English.
Successful completion of Health Care Sanctions background check.

EDUCATION/EXPERIENCE:
Bachelor’s degree in healthcare, business or related discipline, Master’s degree preferred.
Juris Doctorate preferred.
Minimum 5 years’ experience working with Medicare and Medicaid.
10+ years of supervisory or management experience.
Associate in Risk Management-Enterprise-wide (ARM-E): strongly preferred.
Enterprise Risk Management (ERM): preferred.
Familiarity with Medicare and Medicaid laws, rules and regulations.

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 10/2/2019 3:01:22 PM