Vice President, Health Plan Compliance & Regulatory Affairs

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time offand 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Participates in the development of long- and short-term strategic goals for VNS Health Health Plans, consistent with overall VNS Health objectives and ensures compliance with all federal and applicable state laws and regulations related to the governance of Medicare Advantage Organizations (MAO) and NYS Medicaid Health Insurance Plans.
• Gathers internal and external information regarding current industry practices and trends to develop and maintain VNS Health compliance plan. Ensures effective implementation of the VNS Health Compliance Program. Creates an annual work plan to be used as a guideline throughout the program to ensure compliance with regulatory requirements.
• Oversees audits and monitoring activities of internal operations and external vendors consistent with the work plan. Collaborates with Operational leadership, Quality, Human Resources, Legal, and others as appropriate, to implement audits and corrective action plans, as needed.
• Ensures consistency in the application of disciplinary actions related to violations and incidence of non-compliance.
• Collaborates with Education department to ensure all VNS Health Health Plans staff have the appropriate tools and training necessary to adhere to the VNS Health Compliance Programs.
• Educates staff to ensure the prevention of illegal, unethical or improper conduct that places consumers or the Health Plan at risk.
• Develops and coordinates staff training on topics related to regulatory compliance and Fraud, Waste and Abuse. Monitors and oversees compliance for First-Tier, Downstream and Related Entities, including creation and application of training, education and communication requirements and producing proof/attestations to show compliance thereof.
• Ensures timely responses all compliance-related reports and inquiries received through internal and external sources including compliance hotline.
• Acts as point person and liaison for staff at CMS and DOH who provide oversight of VNS Health programs. Submits and obtains DOH and/or CMS approvals for new/revised policies, procedures, subcontracts, letters, notices, and marketing materials, as necessary. Reviews and evaluates new regulations and practices to ensure that internal policies are consistent with Federal and state regulations. Serves as subject matter expert to program and related corporations.
• Acts as resource for VNS Health staff regarding the CMS and state regulations, contracts, and policies that govern VNS Health actions. Researches policy/regulatory questions, when necessary, including, but not limited to consultations with government representatives from CMS and/or DOH, as well as internal and external attorneys and subject matter experts.
• Assesses and monitors progress on areas of regulatory exposure and risk through audits and discussions with Compliance Managers. Develops summary reports of findings for the senior management team, including the President, Executive Leadership, the Audit Committee of the VNS Health Board, and the VNS Health Health Plans Board of Directors, and constantly refines performance measures based on audit findings.
• Collaborates on the implementation of new initiatives and projects for VNS Health Health Plans. Directs the process for securing agency licensure, as required. Assists the President of VNS Health Health Plans with the preparation, development and submission of new initiative proposals.
• Participates with other VNS Health staff in interacting with social, governmental, health and community agencies in identifying and influencing public policy issues that relate to the Program. Represents VNS Health Health Plans internally and externally and increases public awareness of program through education, presentations and marketing of services.
• Creates and maintains an environment that encourages reporting of concerns and allegations throughout the organization in a non-punitive way; serves as a resource to staff with regard to compliance-related matters and questions.
• Performs all duties inherent in a senior managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes and terminates staff and recommends salary actions, as appropriate.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:
Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.

Education:
Master's Degree in Nursing, Health Administration, Public Health, Social Work or other related field required

Work Experience:

• Minimum ten years of progressively responsible compliance, regulatory, or policy related management and leadership experience required
• Minimum of five years of second level supervision required
• Minimum of five years working in health care provider/human services or managed care environment required
• Strong knowledge of State, Federal and other governmental regulations and industry standards and requirements, which govern long term and managed care programs required
• Familiarity with operational, financial, quality assurance, utilization management, and human resource procedures and regulations required
• Conflict resolution, negotiation, and delegation skills required
• Demonstrated ability to design and implement corrective action plans required
• Strong written and verbal communication and interpersonal skills required
• Basic proficiency in PC software applications such as Excel, Work, PowerPoint and Access required