Director - Compliance Investigations 9/8/2016
Woodcliff Lake, NJ
JOB DESCRIPTIONAPPLY MUST HAVES
The successful candidate will possess the following attributes:
* Outstanding leadership, management, interpersonal and prioritization skills;
* Sound judgment and analytical ability;
* Strong intellectual curiosity and a desire to keep abreast of the rapidly changing health care landscape especially regarding government regulations as they affect health plans focused on Medicare/Medicaid;
* Ability to evaluate complex health care compliance issues and make appropriate recommendations;
* Strong project management skills; the ability to prioritize and reprioritize a large caseload that is continuously in flux
* A high emphasis on personal integrity and dedication to conducting all business matters in accordance with the highest ethical standards.
College Degreerequired; advanced degreepreferred.
QUALIFIED CANDIDATES MUST HAVE:
* At least ten years of investigations experience, either as a practicing litigation attorney or as an investigator in a federal or state agency;
* Significant experience managing broad, complex investigations;
* A deep understanding of the full array of viable paths, and project plans, for internal compliance investigations and best practices for developing an evidentiary record;
* Superior three-dimensional analytical, verbal and written communication skills and the ability to collaborate with, and influence, senior executives and other key stakeholders;
* Sound judgment that results in appropriate and effective decision making with respect to collaboration with other corporate functions; internal escalations; and communications with and disclosures to stakeholders such as federal and state government clients, regulators and enforcement officials;
* Experience in a compliance role in a highly regulated industry, preferably healthcare, in a mid to large cap organization;
* A strong operational understanding of applicable federal and state privacy and securitylaws and regulations;
* Experience managing internal investigations and relationships with outside counsel and regulatory agencies;
* Demonstrated successful leadership in developing and implementing best practices in the compliance investigations function;
* A successful track record in all facets of organizational development, including cultivating and recruiting talent, achieving structural efficacy and succession planning;
* Experience training all personnel who are involved in compliance investigations;
* Proven ability to identify trends and/or potential risks and champion the compliance vision and business impact to ensure buy-in across the organization
Applicant must meet ALL of these requirements. Description:
The candidate will:
* Manage the Compliance ""Helpline"" reporting system to ensure consistent, accurate and timely recording of case-specific information.
* Oversee Compliance Investigations and, in conjunction with the Legal Department, provide direction for processing and evaluating internal inquiries and allegations and external complaints, and for conducting investigations of compliance matters across all business areas;
* Build and maintain strong collaborative working relationships across the Company and federal and state regulators,
* Maintain investigation processes and procedures to ensure a consistent framework for compliance investigations and related documentation;
* Provide investigation reports to the Chief Compliance Officer, the General Counsel and other members of the senior management team;
* Ensure that appropriate and prompt investigation and resolution of compliance complaints and reports of potential violations;
* Interact with federal and state regulatory agencies when necessary, appropriate or requested;
* Ensure the Company consistently communicates and enforces its policy of non-retaliation with respect to any associate who, in good faith, expresses a compliance-related concern or reports a potential violation
* Collaborate across all various functions and promote the development of cross-departmental processes with the organization to identify and mitigate compliance risk trends;
* In collaboration with the Legal Department, implement appropriate policies and procedures to ensure consistency and timeliness in the investigation and disposition of compliance-related allegations, complaints and reports;
* As appropriate under the circumstances presented, ensure that all stakeholders, including those who have expressed or reported concerns, are kept timely apprised of the status of the process and of any remedial measures undertaken as a result of the internal review;
* As appropriate and necessary, provide investigative guidance and support to other business functions on non-compliance related matters.
* Partner closely with area and functional leaders, and external resources, to implement monitoring activities, as required.