Director Compliance Program Integrity

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Director, Compliance Program Integrity
Oversees the direction, management and goal setting for Compliance Program Integrity operations and ensures development of outcome programs to support the direction for **MEMBERS ONLY**SIGN UP NOW***., Lucile Packard Children’s Hospital Stanford, University Healthcare Alliance, Packard Children’s Health Alliance, ValleyCare Hospital and other affiliated clinical organizations. Leads compliance initiatives to prevent, detect and respond to internal and external compliance risks and conducts enterprise risk assessments, investigations and risk mitigation. Works collaboratively with administrative and clinical leadership and advises on the development of documented operational controls and effective processes and practices that demonstrate appropriate execution of compliance regulatory requirements. Ensures general Compliance Program Integrity to meet and exceed U.S. Department of Health, Office of Inspector General (OIG) compliance guidance components and elements of an effective compliance program, including the development and distribution of written standards of conduct, policies and procedures that promote the organization’s commitment to compliance; the development and implementation of regular training and education; oversight and maintenance of the compliance hotline and processes to receive and resolve complaints and concerns; development and management of policies and processes to respond to allegation of improper or illegal activities; auditing and monitoring to ensure compliance with applicable regulations, policies and OIG elements of an effective compliance program; processes to ensure non-employment/engagement of individuals or entities excluded from participation in federal health care programs (sanction checking). Ensures the development, improvement and maintenance of a comprehensive Compliance Plan, organizational Code of Conduct, annual audit and monitoring plan to demonstrate compliance with the elements of an effective compliance program, and Compliance Department quality assurance activities to ensure Compliance Program Integrity functions are operating effectively and efficiently. Assists the Chief Compliance Officer with management of the organizations compliance committees and other committees that address compliance issues; leads Compliance Department operations for enterprise risk assessment and mitigation processes. Ensures the Chief Compliance Officer is routinely briefed in a timely manner on matters of potential non-compliance. Researches and provides analysis on federal and state laws and regulations; monitors regulatory-watch activities on new and developing laws and regulations. Develops standards to measure Compliance Program Integrity effectiveness and works continuously to improve program effectiveness; compiles, analyzes and integrates reports, spreadsheets, benchmarks, data and metrics for continuous improvement of the Compliance Program Integrity functions, productivity, and outcomes; develops tools, forms, and educational materials to improve organizational Compliance Program Integrity performance. Assists organizational administrative and clinical leadership with compliance matters to ensure a culture of compliance. Obtains sufficient, competent and relevant regulatory documentation to afford a reasonable basis for analysis, judgment and conclusions; stays current with applicable government rules and regulations and maintains current compliance information, including OIG model compliance guidance, Advisory Opinions, Fraud Alerts, Bulletins, False Claims Act, Stark, Anti-Kickback, EMTALA, Conflict of Interest, California Title 22 and other applicable laws and regulations; serves as subject matter expert and resource regarding applicable compliance laws and regulations. Develops long-range and short-term goals, objectives and plans to assure the development, implementation, maintenance and improvement of compliance effectiveness. Conducts complex investigations of allegations of regulatory and compliance violations, manages and maintains case report documentation, develops mitigation plans and makes corrective action recommendations to organizational leadership, conducts follow up and monitoring activities. Conducts investigations and prepares formal responses to external federal and state investigation and develops corrective action plans and subsequent monitoring plans. Identifies and manages metrics and performance goals for the Compliance Program Integrity team; sets metrics for each level of staff and team performance; establishes criteria for reporting to support day-to-day program management; establishes and maintains metrics to demonstrate progress towards goals and effectiveness of the Compliance Program Integrity program; works continuously to improve the Compliance Program Integrity program. Communicates effectively to facilitate positive working relationships and achieve desired outcomes. Serves as positive role model and effective liaison for the organization and its internal and external community; works collaborative with leadership to foster a culture of compliance integrity throughout the organization.

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