Director of Compliance

Job Description

Job Description

About CHOICE:

CHOICE is a leading Care Management Agency serving Westchester County in New York. Our Vision is a world where all people have a foundation to meet the challenges of everyday life. We are a dynamic not-for-profit organization which operates in the fast-changing environment of healthcare reform. Funded by Medicaid and government grants, we strive to maximize positive human outcomes as we deliver our services to our clients. CHOICE's core Mission is to help people restore and maintain their dignity and well-being regardless of their economic, mental, emotional, or physical conditions or limitations. We do this by providing Mental Health Advocacy and Peer Support, Homeless Outreach Programs and Services, and Mental Health Care Management and Support to those in need.

Essential Functions of the Role:

This position records, aggregates, analyzes, and reports audit results, identifying error trends and root causes, and making recommendations for performance improvements.

Conducts standard random and focused audits to determine compliance to all funding sources list here but not limited to: Medicaid, OMH, Westchester County Department of Mental Health, DOH. Identify and recommend process improvement initiatives based on audit trends. Maintain accurate database of audit results.

Responsible for ensuring compliance with all required staff trainings in conjunction with HR department. Develop new or implement existing trainings based on trends from audit results. Conduct trainings as needed. Collaborate with senior staff members and Staff Development Department to evaluate and improve training curriculum on an ongoing basis.

Initiates, facilitates, and promotes activities to foster compliance awareness and to encourage reporting of compliance issues within the organization and related entities.

Educate employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process and Medicaid, PHI as well as to conduct trainings in other areas as needed..

Identify and recommend process improvement initiatives based on audit trends.

Maintain accurate database of audit results.

Participate in the review of departmental productivity and performance reports and takes an active part in the development of action plans for agency performance improvement.

Remain updated on all member and provider policy changes made by the Health Home, Medicaid, OMH DOJ and other governing agencies. Update existing or draft new policies to reflect current regulations.

Work with all departments to ensure member satisfaction and timely resolution of grievances and appeals reports.

Manage database and spearhead review process for agency incidents, complaints/grievances.

Work closely with the Corporate Compliance Committee to draft and review existing policies on an ongoing basis to ensure alignment with new/updated regulations and determine effectiveness of adoption cross-departmentally.

Perform other duties as assigned

Qualifications for this Role:

• MSW, MBA, MPH or related MA/MS degree, or Bachelor’s Degree with 5 years’ experience including a minimum of 2 years’ experience in quality assurance and compliance in the non-profit sector.
• Strong understanding of NY State Medicaid Redesign, DOH Health Home Regulations, 18 NYCRR Part 521 and SubPart 521-1, as well as OMIG Audit Protocols.
• Strong administrative, managerial and leadership skills.
• Strong verbal and written communication skills
• Excellent computer skills (MS Word & Excel) required
• Understanding of social service programs, including program planning, operations, and evaluation
• Ability to prioritize and handle multiple tasks
• Ability to synthesize information and transfer it to practice
• Excellent organizational skills
• Creative problem solver
• Ability to exercise initiative and “follow through”
• Demonstrated experience developing and implementing training programs.
• Knowledge of NY State Medicaid Redesign and DOH Health Home Regulations preferred
• Experience writing policy and procedure for non-profits
• Flexible, works well independently, with strong attention to detail

Compensation range : $90,000-$110,000