VP Healthcare Compliance -Pennsylvania

The French Group has been retained by this award-winning Health Plan to conduct a national search for a Vice President of Compliance. This role reports to the SVP Chief Legal and Risk Officer.

POSITION SUMMARY

Oversee and maintain compliance with contractual and regulatory obligations and State and Federal requirements related to health insurance and managed care. Develop and maintain compliance-monitoring tools as regulatory/contractual obligations change and make recommendations on proposed regulatory and policy changes. Ensure company maintains positive relationships with legislative/policy bodies affecting managed care, State, Federal, and industry issues.

Implement and continually refine the organizational Compliance Program for all lines of business (Medicare Advantage/Prescription Drug Program, Pennsylvania Medicaid, Pennsylvania CHIP) through defining the Program structure, educational requirements, reporting, and complaint mechanisms, response and correction procedures, and compliance expectations of all personnel and vendors.

BACKGROUND/EXPERIENCE DESIRED

Education: Bachelor’s degree required, Master’s degree and/or Law degree preferred.

Skills/Abilities: The ideal candidate will have a proven track record of creating and managing a successful and fully integrated health care compliance program. 10+ years’ experience in managed care with Medicaid and Medicare regulatory compliance experience with a minimum of 3 years in a management position required. Knowledge of CMS rules and regulations required.

The VP Compliance is a critical business leader and contact for regulatory agencies thus requiring superior interpersonal, negotiation, influencing and presentation skills. The VP Compliance must have a successful track record for oversight and management of Medicare and Medicaid Compliance with a proven ability to lead transformation and promote accountability. The successful candidate will also have strong strategic and analytical skills as well as excellent oral and written communication, time management and organizational skills.

CONSULTANT

Tricia French RN, BSN
President & CEO
The French Group
(757)362-0202 |
tfrench@frenchgroup.com