Director, Compliance

Under the supervision of the Vice President of Compliance, the Director of Compliance is responsible for developing and maintaining a comprehensive compliance and risk management program along with overseeing the audit management program and resources, implementation of compliance education and training, and initiation of compliance projects to ensure organizational integrity. The position supports the Vice President of Compliance, in fulfilling her/his oversight role by providing management, oversight, and assessment of the clinical and operational practices of the organization in comparison to regulatory requirements.

Functional Category:
Risk Management, Operational Compliance Oversight, and Compliance Audit Oversight

Estimated Percent of time Spent – 100%

• Manage the Compliance Department of the assigned area including direct supervision of the Compliance Audit Manager and SDAG Manager in alignment with the goals of the Compliance Program.
• Administers and provides recommendations to minimize risk and ensure the organization's compliance with standards, laws, rules and regulations applicable to the provision of healthcare, treatment and associated services.
• Perform and manage audits of documentation, functions, and departments in all business lines to ensure adherence to regulatory guidance.
• Oversee the organizational practices to assess compliance with regulations and government agencies regarding service documentation.
• Directs the day-to-day compliance and risk management activities including regulator communication, oversight of regulator deliverables, oversight of SDR, appeals, and grievances, investigating compliance allegations, and serves as a compliance and risk management resource for staff.
• Promptly investigate reports of non-compliance or suspected violations of non-compliance and implement corrective actions as deemed appropriate.
• Provides support, oversight, and final submission of the enrollment denial and voluntary/involuntary disenrollment process.
• Acts as a lead for all regulatory contact for PACE programs, CMS, State Administering Agencies, and State licensing agencies.
• Acts as the lead for regulatory surveys from notification through the closing of a corrective action plan.
• Increase communications with providers, operations, and nursing to establish working relationships which encourage consistency with compliance practices and expectations.
• Provides aid to team members for the oversight and coordination of concurrent and retrospective audits of documentation, departments and functions to ensure adherence to regulatory guidance.
• Reports deficiencies found during audits to the VP of Compliance and Chief Compliance Officer.
• Prepares requested reports by collecting, analyzing, and summarizing relevant information obtained through investigations, and other compliance activities.
• Ensure all policies and procedures in the practice setting adhere to applicable laws, rules, and regulations.
• Directs internal corrective action to reduce regulatory non-compliance.
• Participate in leadership meetings to promote compliance initiatives and respond to concerns raised.
• Assist with audit & compliance related special projects as requested.
• Develop audit processes and maintain audit tools for use in all lines of business.
• Manages the participant internal and external appeals process to ensure compliance with PACE and State regulations.
• Assists with policy and procedure development and maintenance.
• In collaboration with the Operations and the Education Department, designs and develops training initiatives/interventions to support compliance efforts and to address non-compliance.
• Participates in Level 2, Quality and Account Management meetings and calls with regulators.
• Maintains current knowledge of regulatory guidance governing Innov Age entities and standards of compliant practice.
• Works in collaboration with Center leadership to communicate ongoing areas for oversight and non-compliance concerns.
• Performs other related duties as assigned.

Estimated Percent of time Spent – 40%

• Travel between Innov Age worksites
• Overnight travel out of state as needed

Remo…