Manager Compliance Operations-SWHR-Care N’ Care

Southwestern Health Resources-Care N’ Care, (SWHR-CNC), is looking for a qualified candidate to join our team.

If you’re looking for a rewarding career at a patient-centered organization with work-life balance and comprehensive benefits, we want to hear from you.

Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region’s leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N’ Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region.

The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation’s leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.

At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.

Position Highlights

The Manager of Compliance Operations SWHR CNC will provide leadership to support the Compliance Director and Compliance Program to ensure business integrity and compliance with all federal and state laws, contract provisions, and internal policies/procedures. The Manager of Compliance Operations SWHR CNC will be primarily responsible for the development, oversight, monitoring and execution of compliance activities including, but not limited to: reviewing, understanding and implementing CMS and other regulatory requirements, CMS marketing compliance, conducting compliance assessments and remediating compliance issues when needed, in partnership with operational and clinic leaders.

• Work location: Southwestern Health Resources Headquarters, Farmers Branch, TX. This position can be eligible for remote work depending on approved states.

Position Duties:

Work with Compliance Director on:
The general development of the Compliance Program including, but not limited to, developing the Compliance Work Plan, Fraud, Waste and Abuse Plan and Compliance policy and procedures.
The implementation of the Compliance Program, policies and procedures designed to ensure compliance with all applicable federal laws and Medicare Advantage and Prescription Drug Plan (MA-PD) regulations.

Maintain and update department policies and procedures as necessary to reflect changes in federal and state laws and regulations.
Participate in the compliance review and approval process of marketing material and required annual mailings (i.e., ANOC/EOC, Summary of Benefits, Provider Director, etc.).
Coordinates internal and external audits ensuring timely submissions for audit requests, monitoring compliance with standards and tracking corrective action plans to completion.
Oversee Medicare Part C&D Reporting requirements, including CMS Data Validation Audit processes.

Revises and develops audit tools to reflect current standards, contract changes, and regulations.
Audits operational areas including FDRs to ensure compliance with regulatory requirements. Implements, manages and/or monitors corrective action for identified deficiencies.

Participates in the development of compliance training/educational materials and provides training as assigned, educating departments on specific compliance requirements.
Serves as a resource and Compliance subject matter expert to highlight key areas of compliance risk and collaborates with internal and external stakeholders to put forth recommendations for process/system enhancements.
Assists with conducting investigations involving instances of non-compliance.
Prepares reports for the Compliance Committee, Board of Directors, and other oversight committees as necessary

Review and interpret HPMS memos and summary guidance ensuring regulatory requirements are tracked and documented through completion.
Assists and supports compliance-related projects and initiatives, participating collaboratively in staff meetings, committees, projects and teams to resolve issues and meeting compliance program goals.

Qualifications

Education
H.S. Diploma or equivalent with 9 additional years experience required. Or, Bachelor's Degree and 5 years experience preferred.

Experience
5 years experience in Medicare Advantage Prescription Drug Plans (MA-PD) or Managed Care regulatory compliance. Experience with CMS and the regulatory requirements within a Medicare program including the Bid process, Network regulatory requirements, reporting requirements, external auditing, sales and marketing compliance experience. Must include 3 years of supervisory experience with bachelor's degree. Or, 9 years experience in Medicare Advantage Prescription Drug Plans (MA-PD) or Managed Care regulatory compliance. Experience with CMS and the regulatory requirements within a Medicare program including the Bid process, Network regulatory requirements, reporting requirements, external auditing, sales and marketing compliance experience. Must include 3 years of supervisory experience without a bachelor's degree required.
4 years prior experience working with a compliance program and prior experience in auditing in a healthcare organization is preferred.

Licenses and Certifications
CHC - Certified in Healthcare Compliance preferred upon hire

Skills
Advanced skills with MS Office tools (including Excel, Word, PowerPoint).
High degree of interpersonal skills, problem solving abilities, and excellent communications skills.
Ability to review, analyze, and interpret regulatory requirements in a clear and concise manner.
Demonstrated analytical skills to assess and synthesize information; identifying key factors, trends and issues; identify and summarize possible risk and implications for the organization through assessments and audits. Project Management and organizational skills to meet strict deadlines in an environment of multiple projects and changes.

Why Southwestern Health Resources

As a Southwestern Health Resources you’ll enjoy: comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Let’s move healthcare forward – together. #IndeedTXHLeadership

Job Type: Full-time

Pay: From $100,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Supplemental pay types:

• Bonus pay

Work Location: Hybrid remote in Farmers Branch, TX

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