Job Description

Job Title: Senior Administrator, Regulatory Compliance
Job ID: 23919921
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: Community Care Behavioral Hlth
Department: Compliance
Location: 339 Sixth Avenue, Pittsburgh PA 15222

Description

Are you a proven leader with a minimum of five years of health insurance (payer) legal and/or compliance experience? Are you a driven individual looking to not only tactically ensure compliance but also be a part of program development? If so, we may have an opportunity for you!

UPMC is actively seeking a full time Senior Administrator, Regulatory Compliance to support UPMC Community Care Behavioral Health! This will be a Monday through Friday daylight role located in downtown Pittsburgh, PA.


The Senior Administrator, Regulatory Compliance reports to the Community Care Behavioral Health Organization’s Director of Compliance and, in collaboration with Community Care’s Director of Compliance, will be responsible for establishing and supporting a robust internal Compliance and Ethics Program.  This Program serves to promote the highest degree of ethical and lawful conduct throughout Community Care by examining, evaluating, and coordinating processes that demonstrate compliance with all applicable rules and regulations, as well as all other federal, state, and local laws.

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, procedures, training, communications and awareness materials, campaigns, controls and initiatives to ensure clear and consistent understanding and practices throughout internal and external operations to ensure proper and timely preventive measures.
  • Develops, assesses, and adapts clear and effective Compliance monitoring, testing, reporting, auditing and sampling protocols, controls and channels 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 new or prospective laws, regulations, contractual requirements, industry standards and best practices.
  • Works with Director to conduct annual and ongoing Compliance training to Community Care staff and applicable parties.
  • Works with Director to complete regular gap analyses, risk assessments and program effectiveness assessments for the Compliance Program.
  • 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.
  • Represents Community Care with all relevant regulatory agencies and entities regarding Compliance reviews, investigations or requests for information.
  • Assists in the development of clear, effective and timely reports and updates for senior management and/or the Board regarding the
  • Compliance Program effectiveness, initiatives and issues, including all relevant metrics, dashboards and information.
  • Performs other duties as assigned.
  • Effectively lives, models, communicates and supports the values of Community Care.
  • Performs in accordance with Community Care wide competencies and behaviors.

Qualifications

  • Bachelor's degree required. Relevant graduate degree (e.g. Juris Doctor or master’s degree in a related field) preferred.
  • Minimum of 5 years of compliance experience required on the insurance (payer) side.
  • Prior in-house legal or compliance experience strongly preferred.
  • Pennsylvania-specific experience preferred, but not required.
  • Successful experience in designing and building highly effective relevant compliance programs from scratch and/or significantly enhancing such programs strongly preferred.
  • Strong subject matter expertise and knowledge of all relevant laws, regulations, contractual requirements, industry standards and best practices required.
  • 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.
  • Must have strong analytical and organizational skills as well as problem-solving capabilities to ensure that business plans and strategies do not subject the organization to legal, regulatory or contractual violations and/or undue risk or exposure.
  • Strong partnership, relationship, consensus and coalition-building skills required.
  • Strong emotional intelligence and self-awareness required.
  • Strong executive polish and presence required. The 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 Commercial related issues.
  • Strong ethical compass and integrity capital required.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $35.66 to $60.38 / hour

Union Position: No

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UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.


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