Industry: Healthcare

Mulberry Talent Partners has joined with our client, a company located in Downtown Portland to identify a Director of Compliance to join their team. This is a full-time, direct-hire, hybrid position with three days in the office and two days remote. This role will have overall responsibility for planning and executing company’s corporate compliance and professional standards programs; for managing company’s URAC accreditation and state licenses; for maintenance of corporate policies and procedures; for monitoring and implementing the compliance program, for leading internal and client audits to ensure adherence to accreditation, regulatory, and client standards.

Your Role:

  • Develops and maintains policies, procedures and systems that ensure effective compliance with applicable laws and regulations and prevent unethical or improper conduct
  • Identifies areas of compliance vulnerability and develops corrective action programs as necessary
  • Provides reports to Management and the Board of Directors regarding compliance issues
  • Researches and tracks changes in federal and state health care statutes and regulations; implements changes in policies and procedures to comply with statutory requirements
  • Oversees business processes ensuring policies and procedures comply with regulatory requirements
  • Develops, delivers and coordinates compliance training and orientation to all employees, peer reviewers, contractors, and all other business associates
  • Prepares and leads internal and client-based audits, including annual delegation audits and random compliance audits
  • Reviews contracts prior to execution and identifies compliance requirements for population served
  • Provides support to clients, sales and other departments regarding contractual, compliance and accreditation issues
  • Maintains updated knowledge regarding URAC accreditation and NCQA delegation requirements
  • Prepares applications for URAC accreditation and state certification/licensure, and acts as liaison with licensing body
  • Responds to surveys, completes mandatory attestations, and provides reports to URAC and licensing bodies
  • Compliance Office Participation in NAIRO becoming a member of the Legislative / Regulatory / Accreditation Committee
  • Establishes processes and reporting systems to track access to protected health information, within the purview of company and as required by law
  • Establishes and administers the process for receiving, documenting, tracking, investigating, and taking actions on all complaints concerning company’s privacy policies and procedures
  • Investigates, remediates/mitigates, and reports potential and actual privacy violations
  • Ensures compliance with privacy practices and consistent application of sanctions for failure to comply with privacy policies for all staff and business associates
  • Cooperates with the Office of Civil Rights and other legal entities in any privacy reviews
  • Participates in the development and implementation of corporate strategic plans
  • Assists staff to insure the integrity of the case review process
  • Maintains confidentiality as defined by state, federal, and company regulations and policies

You Bring:

  • Bachelor’s degree (B.A./B.S.) or equivalent four-year degree
  • 2-5 years of healthcare professional standards experience
  • Proven ability to perform risk assessments and advise senior management on best course of action
  • Ability to partner with cross-departmental stakeholders in regards to compliance requirements
  • Exhibits a high degree of professionalism in written and verbal communications with the ability to effectively explain the potential impacts of compliance requirements on the business
  • Professional exposure to either URAC or NCQA accreditation standards
  • Understanding of CMS, HHS and ERISA standards and regulations
  • High degree of computer literacy with demonstrated proficiency in MS Office and web-based applications
  • Ability to effectively present information to regulatory officials, referring entities, and office staff

Compensation: $130,000 – $140,000/year