Job Description

Job Title: Senior Director, Regulatory Compliance
Job ID: 45638880
Status: Full-Time
Regular/Temporary: Management
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Compliance & Ethics
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
The Sr. Director, Regulatory Compliance reports to the Associate VP, of Corporate Compliance & Ethics and strategically leads the development, implementation and management of a robust and effective Regulatory Compliance Program which includes licensure application process for UPMC's large and growing Insurance Services Division as well as compliance oversight for Community Care Behavioral Health. This position ensures strong regulatory review, judgement and interpretations along with effective compliance communication to the organization. This is an exciting opportunity for a highly experienced functional expert to lead the vision, processes and tools for an effective regulatory program.

Responsibilities:
  • Ensures compliance with required laws, regulations, contractual requirements, standards and practices for all relevant stakeholders, both internal and external to the organization.
  • Develops, assesses and adapts clear and effective compliance policies as needed for state and local licensure applications
  • Develops, assesses, and adapts clear and effective compliance monitoring, reporting, to ensure the proper and timely detection of relevant issues
  • Develops, assesses and adapts clear and effective remediation and corrective action initiatives, protocols and controls to ensure proper and timely compliance
  • Keeps abreast of changing industry requirements and regulations, including all relevant laws, rules, contractual agreements, industry standards, company practices and initiatives
  • Provides clear and effective reports to the relevant business, functional and operational areas, as well as other internal/external stakeholders, regarding laws, regulations, contractual requirements, industry standards and best practices for licensure applications and requirements for renewals
  • Provides oversight for Community Care Behavioral Health Compliance Program including expansion of program to other states
  • Assists with gap analyses, risk assessments and program effectiveness assessments for the Corporate Compliance & Ethics Office
  • Ensures strategic and operational partnership and collaboration with the business and operational areas, as well as with sibling Governance, Risk & Compliance (GRC) teams to leverage cross-departmental synergies and efficiencies
  • Performs other duties as assigned
  • Effectively lives, models, communicates and supports the values of UPMC and UPMC Health Plan Performs in accordance with UPMC System-wide competencies and behaviors
  • Develops and delivers clear, effective and timely reports and updates for senior management and/or the Board regarding the new and existing licensure, regulatory reporting and all relevant metrics, dashboards and information

Qualifications

  • Bachelor's degree required, Master's degree or JD preferred
  • Minimum of eight years of health insurance (payer) legal and/or compliance experience required.
  • Prior in-house legal or compliance experience strongly preferred.
  • Pennsylvania-specific experience preferred, but not required
  • Minimum of five years of work experience in a managerial/leadership role (i.e., managing a team, directly or indirectly)
  • Proven ability to effectively and timely manage multiple initiatives and cross functional department projects
  • Strong regulatory research background and knowledge of relevant laws, regulations, industry standards and best practices required for licensure application for health insurance, third party administration as well as workers compensation
  • Strong acumen and understanding of healthcare, health insurance and managed health care industries and organizations required
  • Excellent oral, listening and written communication skills
  • Strong project management skills and experience required, particularly as it relates to managing and leading across large and matrixed organizations
  • Executive polish and presence required
  • This role requires a leader who strikes the optimal balance between strategically navigating the compliance requirements and business needs in a manner that is nuanced and mutually reinforcing
  • Strong strategic, business, operational and leadership mindset and skills required
  • Highly consultative and partnership-oriented in approach
  • Strong and reliable judgment and discretion required.
  • Strong ability to independently and self-sufficiently identify, navigate and successfully resolve various compliance, risk management and licensure expansion requirements
  • Strong ethical compass and integrity capital required


Licensure, Certifications, and Clearances:
Licensure/Certification:CHC certification preferred


UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $0 / hour

Union Position: No

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