In order to be considered for this position, must CURRENTLY reside in the D.C. /  DMV region.  This position incorporates a hybrid work schedule working 1 day remotely and 4 days a week at our AmeriHealth DC office located 1201 Maine Avenue, S.W., Suite 1000, 10th Floor, Washington, DC 20024

Responsibilities:

The Director, Compliance, will be responsible for the strategic direction and leadership for the development and implementation of policy, process and control activities consistent with the seven elements of a Compliance Program as defined by 42 CFR 439.608(b), provides oversight of all operating divisions and subsidiaries across compliance and regulatory functions, including overseeing a staff responsible for state regulatory and contractual monitoring.   This person serves in the role of AmeriHealth DC Market Chief Compliance Officer, Privacy / Security Officer and Program Integrity Director.  

Essential Functions

Policy and Procedure Development  

• Responsible for developing, implementing, reviewing, and revising policies, procedures, and practices designed to make sure the business is in compliance with the contract and state and federal laws and regulations.

Compliance Oversight

• Accountable for the annual creation, implementation, and monitoring of the D.C.  compliance plan and execution of work plan activities.
• Accountable for leading, creating, and implementing the line of business (LOB) Compliance Committee and its charter.
• Accountable for documenting, aggregating, and reporting LOB compliance related issues and risks to senior leadership, the Regulatory Compliance Committee, Board of Directors, and other committees, as applicable. · 
• Provides strategic direction and leadership for the development and implementation of compliance policy, process and control activities. · 
• Collaborates with LOB executive leadership on LOB contract amendment processes and responsible for the communication of contract changes and monitoring the implementation. Collaborates with the Program Integrity department, to oversee compliance with fraud, waste, and abuse activities. ·
• Collaborates with the Privacy department to oversee compliance with privacy incident reporting management.  
• Attends state and federal regulatory meetings as appropriate or required by contract.

Education, Training and Requirements

• Responsible for the creation, implementation, and monitoring of compliance training, education, and communication programs.

Reporting, Investigating, Monitoring and Auditing

• Responsible for the communication, oversight and monitoring the implementation of changes required by state and federal regulations and guidelines.
• Responsible for oversight and monitoring compliance with federal, state and contractual performance metrics and requirements
• Documents and investigates potential Code of Conduct and other non-compliance issues reported via the LOB and enterprise compliance reporting mechanisms.
• Develops compliance methodologies and ad-hoc compliance assessments/reviews to test established and newly executed operational processes and controls.
• Directs ad-hoc compliance research and technical assistance as requested by LOB or corporate associates.

Enforcement and Disciplinary Actions

• ·Partners with LOB and corporate counterparts to consistently hold associates accountable through well-publicized disciplinary standards.

Corrective Actions

• Proactively identify process gaps, weaknesses and deficiencies, and issues corrective actions as appropriate to document root cause and remediation(s).
• Responsible for oversight, development and communication of remediation of regulatory issued correction actions.
• Accountable to timely report issues of non-compliance to regulatory agencies as required.

Education/Experience:

• Bachelor’s Degree required.
• Bachelor’s Degree: Bachelor's degree or equivalent education.
• 5 or more years in a managed health care environment, including experience in the areas of compliance oversight.

Other Skills:

• Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.
• Demonstrates knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication).
• Self-motivated with demonstrated project management skills.
• Demonstrates strong knowledge of Microsoft Office and SharePoint
• Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
• Strong problem solving and critical thinking skills.
• Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.
• Strong organizational skills, with the ability to apply good judgment and resolve ambiguities.
• Acts independently and requires minimal supervision, proactively takes initiative.
• Strong process development and process management knowledge/demonstrated abilities.
• Continuous Improvement mindset; ability to identify and apply improvements.
• Ability to understand contract and regulatory language, prior experience a plus.
• Strong program and project management skills.

The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the Washington DC area. 
Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training. AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more. The targeted hiring range for this role is expected to be between $128,400.00 and $212,400.00.

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.