Job Details

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AlohaCare is a local, non-profit health plan serving the Medicaid and Medicare dual eligible population. We provide comprehensive managed care to qualifying health plan members through well-established partnerships with quality health care providers and community-governed health centers. Our mission is to serve individuals and communities in the true spirit of aloha by ensuring and advocating access to quality health care for all.

The Opportunity:

Position Summary:

The Compliance Director promotes a culture of compliance, ethics, and integrity and is responsible for supporting the Senior Vice President, Compliance and Quality (Compliance Officer) in implementing AlohaCare's Compliance Program. The primary job objective is to assist the organization/department and delegates to meet regulatory requirements and support quality and integrity efforts. Responsibilities include:

• Directing Compliance programs, policies, and practices to ensure that all business units are in compliance with Medicaid and Medicare policy and reporting regulations.
• Assisting with interpretation of federal and state rules, laws, and regulations.
• Identifying and resolving compliance related issues.
• Developing and implementing compliance work plans, policies and procedures, and activities.
• Monitoring and auditing division and/or department functions against regulatory requirements.
• Educating staff on compliance and regulations.
• Communicating compliance issues or regulatory and/or legislative changes to staff and key external stakeholders.

Primary Duties & Responsibilities:

• Manages the day-to-day operations of the organization's corporate compliance program and plan.
• Leads enterprise-wide risk assessments and develops auditing and monitoring plans.
• Manages policies and procedures (P&P) program management ensuring departments review, update, and publish P&Ps timely.
• Coordinates and responds to regulatory audits and inquiries.
• Acts as a liaison with State departments to obtain regulatory approval of all policy documents.
• Co-chairs the Corporate Compliance Committee and subcommittees.
• Develops Regulatory Compliance reports and provides information to the board of directors and executive management as necessary.
• Supports compliance team members in conducting compliance investigations, audits, and reviews.

Required Competencies & Qualifications:

• Bachelor's Degree.
• Minimum of 4 years managerial/leadership position experience.
• 3-5 years of experience in health plan operations.
• Experience with Medicare and Medicaid programs required or equivalent experience.
• Strong written, verbal, and presentation skills.
• Ability to work independently and manage own work assignments with minimal supervision.

Preferred Qualifications:

• Juris Doctor Degree.

Physical Demands/Working Conditions:

• Sedentary Work: Exerting up to 20 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects.

Salary range: $110,000 - $140,000 annually.

AlohaCare is committed to providing equal employment opportunity to all applicants in accordance with sound practices and federal and state laws.