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Job Description

Job Title: Administrator, Regulatory Compliance, Community Care Behavioral Health
Job ID: 896803298
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Compliance & Ethics
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
This Regulatory Compliance role focuses on the compliance for Community Care Behavioral Health.

The Regulatory Administrator, Compliance reports to the Community Care Behavioral Health Organization’s (“Community Care”) 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 (“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.

Community Care’s Compliance Program serves to promote the highest degree of ethical and lawful conduct throughout the organization by examining, evaluating, and coordinating processes that demonstrate compliance with all applicable federal, state and local laws, rules and regulations. 

This role can be located at any of our CCBH locations and there could be very minimal travel, if any. 

Responsibilities:
• Assist and support Community Care’s Director of Compliance in efforts to build, sustain, and expand (as needed) a cohesive and effective Compliance Program.
• Works with the Director of Compliance to conduct annual and ongoing compliance trainings for Community Care staff and applicable parties.
• Works with the Director to of Compliance to complete regular gap analyses, risk assessments and program effectiveness assessments for the Compliance Program.
• Assists the Director of Compliance 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.
• Assists the Director of Compliance to ensure compliance with required laws, regulations, contractual requirements, standards and practices for all relevant stakeholders, both internal and external to the organization.
• Updates key management staff of regulatory changes/developments and implications of new health care legislative initiatives on functional areas of Community Care.
• Works with Director of Compliance and designated departments to coordinate compliance monitoring.
• Oversees preparation of quarterly and annual reports to PA DOH/PID.
• As requested by key Community Care management staff, works with the Director of Compliance on responses to RFPs and any other potential state/county expansion activities.
• Reports on a weekly basis status of all assignments pertinent information obtained during report week. Provides projections for upcoming week.
• 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.
• Assist Community Care’s Director of Compliance create, review and update the Community Care compliance policies annually or as needed.
• Assist Community Care’s Director of Compliance track federal and state legislation, rulemaking, and government program contract modifications applicable to Community Care lines of business and operations.
• 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.
• Works with the Director of Compliance to represent Community Care with all relevant regulatory agencies and entities regarding Compliance reviews, investigations or requests for information.
• Effectively lives, models, communicates and supports the values of Community Care. Performs in accordance with Community Care wide competencies and behaviors.
• Performs other duties as assigned.

Qualifications

  • Bachelor's degree required. Masters degree and/or paralegal certificate preferred. 
  • Previous management/supervisory experience preferred. 
  • 5 years health insurance, government products, or regulatory review required.
  • Experience in PA Managed Care/health insurance 
  • Strong attention to detail 
  • Strong ability to collaborate with other departments
  • Must have strong analytical and organizational skills, as well as problem-solving capabilities to verify that business plans and/or strategies do not place the company in violation of federal, state, or accreditation standards. 
  • Excellent oral and written communication and computer skills.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $32.46 to $55.43 / hour

Union Position: No

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