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Health Care Program Manager
Eingestellt von Enclipse Corp.
Gesuchte Skills: Support, Design
Projektbeschreibung
HEALTH CARE PROGRAM MANAGER ---OAKLAND, CA
Job Summary - This 4+ month contract opportunity is for a Health Care Program Manager role for a major health care provider. The individual in this role will provides professional/technical guidance to team members and employees at large and present complex information throughout the organization. Contribute to the development of the department's objectives and participates in the development of the annual risk assessments, work and audit plans. Could have a primary functional area of emphasis in one or more of these areas: Investigations, Scope of Practice, Privacy, Health Information Management/Coding, Revenue Cycle, External or Internal Auditing or Statistical Analysis.
Major Responsibilities/Essential Functions:
Project Planning: Oversees and/or directs teams in identifying accountabilities for local/regional compliance programs and consulting staff. Leads/manages efforts in developing compliance work and audit plans. Oversees the development and completion of annual risk assessments. Establishes compliance goals, timelines, approaches and strategies in support of organizational initiatives. Establishes and or leads compliance related committees/work groups to cultivate and reinforce appropriate group values, norms and behaviors. Identifies areas of performance improvement and establishes/delegates resources to lead compliance-related projects. Oversees and leads on-going efforts to establish, identifyensures direct reporting team is engaged in change management as appropriate.
Validation (Monitors and Process Controls-30% of time)
Manages and leads audits on scope of practice, licensing, site of service and other identified areas at risk for compliance violations. Responsible for identifying compliance risks and developing related corrective action plans. Assesses completion rates & operational sustainability. Oversees the administration of compliance programs and content, including design, completion of risk assessments and/or audits, investigations processes & activities, instances of reported non-compliance. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Develops communication strategies to address impacts and required changes. Identifies and delegates resources to support risk assessment and implanting required changes. Researches and stays abreast of regulations and statutes exhibiting extensive knowledge on a wide variety of clinical and non-clinical compliance issues.
Development of compliance requirements based on risks
Review of business requirements for risks
Review of processes and work queues
Ensure controls and monitors
Investigations and Incident Management (25% of time): Oversees the administration of investigation processes and activities. Evaluates and performs analyses of investigation activities. Provides guidance and recommendations for next steps. Develops customized investigation activities to address complex, rare or sensitive findings. Leads and manages efforts to identify potential compliance issues and areas of compliance requirements, Establishes and promotes a collaborative environment with other functional areas in investigating potential compliance issues. Establishes framework and strategies for developing and creating investigation project plans. As needed for sensitive or political situations, will participate and assist with investigation interviews, findings and recommendations. Collaborates with clients to determine complex corrective action plans appropriate to substantiated allegations and investigation findings
Incidents are investigated within 90 days
Corrective action plans are developed within 30-45 days of root cause analysis completion.
Timely CAP closure
Implementation (5% of time): Identifies and implements OIG compliance requirements. Leads the identification of compliance requirements and directs related analyses. Performs on-going assessment of established solutions to existing alternatives and makes recommendations as needed to implement changes. Leads and participates in the creation, revisionsincluding but not limited to privacy and security, fraud, waste and abuse, non-retaliation, disciplinary action, vendor relations etc. Leads the monitoring of compliance adherence. Directs reporting on compliance efforts and programs to all levels of the organization. Influences management and staff to ensure compliance and reporting on compliance efforts and programs. Oversees the development and/or delivery of compliance and ethics training.
Educational and Experience Requirements:
REQUIRED: Bachelor Degree in Health Care Administration, Business Administration, Finance,
HIGHLY PREFERRED: Masters degree or equivalent experience in Health Care Administration, Business Administration, Finance, Economics, Operations Research, Public Health or other Health Care related field
Work Experience: 5 - 10 years progressive experience in a Health Care Environment, (managerial or clinical disciplines) with at least five years in healthcare compliance and privacy. Advanced knowledge of compliance principles, theories, and concepts. Extensive knowledge of health care compliance policies, programs, practices, systems, related compliance issues. Thorough knowledge of the elements of an effective Ethics and Compliance program and broad knowledge of health care industry practices and standards including both federal, state regulations and accreditation standards. Excellent Skills in written and verbal communication, meeting facilitation, presentations, analysis, collaboration, project management, decision making, stewardship, negotiation, and leadership. Strong knowledge of federal and state reimbursement program requirements (eg Medicare and Medi-Cal) and privacy and consent laws.
Preferred Work Experience: Focused experience in any of the following areas: Revenue Cycle, Clinical Documentation/Coding, Risk Management, Auditing/Claims Review, Project Management, Defense Auditing. SOX exp preferred - someone with knowledge of Revenue Cycle process and internal controls.
Required Certifications: Certified in Healthcare Compliance (CHC) or other accredited compliance certified
Top 3 preferred skills: Revenue Cycle Background/Experience required (particularly in billing processes), Compliance experience and certification preferred, SOX experience preferred
Job Summary - This 4+ month contract opportunity is for a Health Care Program Manager role for a major health care provider. The individual in this role will provides professional/technical guidance to team members and employees at large and present complex information throughout the organization. Contribute to the development of the department's objectives and participates in the development of the annual risk assessments, work and audit plans. Could have a primary functional area of emphasis in one or more of these areas: Investigations, Scope of Practice, Privacy, Health Information Management/Coding, Revenue Cycle, External or Internal Auditing or Statistical Analysis.
Major Responsibilities/Essential Functions:
Project Planning: Oversees and/or directs teams in identifying accountabilities for local/regional compliance programs and consulting staff. Leads/manages efforts in developing compliance work and audit plans. Oversees the development and completion of annual risk assessments. Establishes compliance goals, timelines, approaches and strategies in support of organizational initiatives. Establishes and or leads compliance related committees/work groups to cultivate and reinforce appropriate group values, norms and behaviors. Identifies areas of performance improvement and establishes/delegates resources to lead compliance-related projects. Oversees and leads on-going efforts to establish, identifyensures direct reporting team is engaged in change management as appropriate.
Validation (Monitors and Process Controls-30% of time)
Manages and leads audits on scope of practice, licensing, site of service and other identified areas at risk for compliance violations. Responsible for identifying compliance risks and developing related corrective action plans. Assesses completion rates & operational sustainability. Oversees the administration of compliance programs and content, including design, completion of risk assessments and/or audits, investigations processes & activities, instances of reported non-compliance. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Develops communication strategies to address impacts and required changes. Identifies and delegates resources to support risk assessment and implanting required changes. Researches and stays abreast of regulations and statutes exhibiting extensive knowledge on a wide variety of clinical and non-clinical compliance issues.
Development of compliance requirements based on risks
Review of business requirements for risks
Review of processes and work queues
Ensure controls and monitors
Investigations and Incident Management (25% of time): Oversees the administration of investigation processes and activities. Evaluates and performs analyses of investigation activities. Provides guidance and recommendations for next steps. Develops customized investigation activities to address complex, rare or sensitive findings. Leads and manages efforts to identify potential compliance issues and areas of compliance requirements, Establishes and promotes a collaborative environment with other functional areas in investigating potential compliance issues. Establishes framework and strategies for developing and creating investigation project plans. As needed for sensitive or political situations, will participate and assist with investigation interviews, findings and recommendations. Collaborates with clients to determine complex corrective action plans appropriate to substantiated allegations and investigation findings
Incidents are investigated within 90 days
Corrective action plans are developed within 30-45 days of root cause analysis completion.
Timely CAP closure
Implementation (5% of time): Identifies and implements OIG compliance requirements. Leads the identification of compliance requirements and directs related analyses. Performs on-going assessment of established solutions to existing alternatives and makes recommendations as needed to implement changes. Leads and participates in the creation, revisionsincluding but not limited to privacy and security, fraud, waste and abuse, non-retaliation, disciplinary action, vendor relations etc. Leads the monitoring of compliance adherence. Directs reporting on compliance efforts and programs to all levels of the organization. Influences management and staff to ensure compliance and reporting on compliance efforts and programs. Oversees the development and/or delivery of compliance and ethics training.
Educational and Experience Requirements:
REQUIRED: Bachelor Degree in Health Care Administration, Business Administration, Finance,
HIGHLY PREFERRED: Masters degree or equivalent experience in Health Care Administration, Business Administration, Finance, Economics, Operations Research, Public Health or other Health Care related field
Work Experience: 5 - 10 years progressive experience in a Health Care Environment, (managerial or clinical disciplines) with at least five years in healthcare compliance and privacy. Advanced knowledge of compliance principles, theories, and concepts. Extensive knowledge of health care compliance policies, programs, practices, systems, related compliance issues. Thorough knowledge of the elements of an effective Ethics and Compliance program and broad knowledge of health care industry practices and standards including both federal, state regulations and accreditation standards. Excellent Skills in written and verbal communication, meeting facilitation, presentations, analysis, collaboration, project management, decision making, stewardship, negotiation, and leadership. Strong knowledge of federal and state reimbursement program requirements (eg Medicare and Medi-Cal) and privacy and consent laws.
Preferred Work Experience: Focused experience in any of the following areas: Revenue Cycle, Clinical Documentation/Coding, Risk Management, Auditing/Claims Review, Project Management, Defense Auditing. SOX exp preferred - someone with knowledge of Revenue Cycle process and internal controls.
Required Certifications: Certified in Healthcare Compliance (CHC) or other accredited compliance certified
Top 3 preferred skills: Revenue Cycle Background/Experience required (particularly in billing processes), Compliance experience and certification preferred, SOX experience preferred
Projektdetails
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Einsatzort:
Oakland, Vereinigte Staaten
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Projektbeginn:
asap
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Projektdauer:
4 months
- Vertragsart:
-
Berufserfahrung:
Keine Angabe
Geforderte Qualifikationen
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Kategorie:
Medien/Design, Sonstiges