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AmeriHealth Caritas Director Compliance in Dublin, Ohio

Director Compliance

Location: Dublin, OH

Primary Job Function: Compliance

ID**: 31571

Job Brief

The office is located in Dublin, Ohio. Contractually must live in Ohio. Will be required to attend meetings in Columbus as needed throughout the month.

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.

Responsibilities:

Must be located in Ohio (per contractual requirements).

Under the direction of the Regional Compliance Director, the Director, Compliance provides strategic direction and leadership for the development and implementation of compliance policy, process and control activities and provides oversight of all operating division and subsidiary compliance, privacy, and regulatory functions, in addition to possessing the following attributes:

  • Demonstrates a solid understanding of operational processes and controls and monitors the execution of operational changes required by regulations and guidelines.

  • Develops compliance methodologies to test established and newly executed operational processes and controls and monitor effectiveness.

  • Proactively identify process gaps, weaknesses and deficiencies and/or business productivity/efficiency opportunities.

  • Partners with local and corporate counterparts to develop protocols that support the review and assessment of objectives that ensure compliance with local plan and corporate policies and procedures.

  • Develops and monitors metrics and ensures accurate reporting of regional/local compliance information and compliance and FWA issues reported via the compliance hotline.

  • Ensure that local compliance related issues and risks are identified, aggregated and reported.

  • Directs ad-hoc compliance assessments/research as requested by the local compliance associates.

  • Aligns and monitors compliance training and education programs.

  • Assists in the development and implementation of the annual enterprise compliance plan.

The Director, Compliance may directly manage and support the development of highly skilled and knowledgeable associates. Must be able to operate independently with minimal management oversight and be able to manage competing priorities and deadlines that are subject to frequent change. Must possess and exercise excellent professional judgment in all interactions.

Education/Experience:

  • Bachelor’s Degree required

  • Advanced degree and/or JD preferred.

  • 5+ years experience in managed care compliance

  • Certified in Health Care Compliance preferred.

  • In a managed health care environment, including experience in the areas of compliance oversight.

  • Good working knowledge of AmeriHealth Caritas, its affiliates and the managed care industry.

  • Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication).

  • Self-motivated with demonstrated project management skills.

  • Strong oral and written communication skills.

  • Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.

  • Strong interpersonal skills.

  • Innovative and creative. Able to embrace change and think outside the box.

  • 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.

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.

EOE Minorities/Females/Protected Veterans/Disabled

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