Kaiser Permanente Regional Compliance Officer - KPNW in United States

Reporting directly to the Regional President and the VP Enterprise Compliance, the Regional Compliance Officer for the Northwest Region (RCO) is responsible for the development, implementation and on-going refinement of strategies for an effective compliance, ethics and integrity and privacy/security program throughout all jurisdictions the region serves. The Northwest RCO is the RCO for KFHP/H entities. The RCO ensures an effective compliance program in all health plan products (Medicare, Medicaid, OPM, Commercial, and ACA Exchanges) as well as within the various care delivery units throughout the region. The RCO leads regional efforts to ensure compliance with the Medicare Part D and other Government Program requirements and provides leadership and oversight of compliance audits, investigations (including Fraud, Waste & Abuse prevention [FW&A]), and corrective actions plans. The RCO directs compliance functions, including Privacy and Security Compliance at the regional level, and they function as an integral member of the senior leadership team in the region. The RCO chairs the Regional Executive Compliance Committee, and is also the compliance contact responsible for the relationship with the regulators throughout the region. The RCO-s authority includes the ability to report directly to the KFHP/H Boards of Directors; interview employees and relevant individuals; review and retain company contracts pertinent to the Medicare Part D and other Government programs; seek advice from legal counsel; report misconduct to CMS, other government agencies or law enforcement; conduct and direct internal audits and investigations of any entities.

Essential Responsibilities:

  • Develop, implement and maintain comprehensive compliance program for the Region, build on existing activities to enhance the infrastructure; partner with operations in the continued development of tools that facilitate ongoing implementation of compliance requirements to include procedure templates, self-monitoring tools, manuals, systematic control reviews and report formats.

  • Medicare Part D - responsibilities include but are not limited to: develop and monitor implementation and compliance with Part D related policies and procedures through the creation and implementation of work plans; reports at least quarterly to the CCO/BOD/CEO on the status of the implementation and ongoing monitoring of the compliance program; identifies and resolves potential or actual instances of non-compliance and on other audit activities.

  • Working closely with NCO, ensure that first tier, downstream and related entities, particularly those involved in sales and marketing activities, are aware of and follow the requirements for Medicare Part D and other sales and marketing activities.

  • Ensure that the regional compliance program meets state and federal regulatory requirements and NCO standards while enhancing organizational performance.

  • Lead regional ethics and integrity initiatives and provide strategic direction on Regional initiatives,(POR/COI etc); assumes dissemination and awareness of POR.

  • Oversee the development of the region-s compliance policies and procedures; assures policies accurately and effectively communicate legal, regulatory and accreditation requirements, and meet internal policies and procedures and ethical standards; periodically reviews and initiates needed updates

  • Collaborate with the National Compliance Office on program wide compliance initiatives.

  • Lead the Regional Compliance Committee; meet at least quarterly; develop strategies to promote compliance; ensure training; assist in CAP activities; develop and implement corrective and preventive actions; oversee internal controls; ensure current policies; ensure retaliation free process for reporting.

  • Oversee the development and implementation of appropriate education and training programs to ensure employees, physicians (where appropriate and/or working in partnership with Permanente Compliance Officer) and management are knowledgeable about their compliance responsibilities and Ethics Programs and, where appropriate, provide the same for all employees with Part D program responsibilities including written standards and the applicable statutory, regulatory and other requirements. Regularly update Executive Compliance Committee and all governing bodies on training status.

  • Oversee and support the development of compliance risk mitigation and corrective action plans

  • Working closely with Human Resources departments, ensure the DHHS OIG and GSA exclusion lists have been checked with respect to all employees, officers, directors, and managers as well as assuring first tier, downstream and related entities are not included on such lists

  • Provide timely reports on compliance issues to regional leadership and NCO.Supervise sensitive compliance investigations and ensure the integrity of the process

  • Oversee the development and implementation of the regional anti-fraud program including the coordination of internal investigations and development of appropriate corrective or disciplinary actions with NCO. Develop and implement methods and programs that encourage managers and employees to report suspected fraud and other misconduct without fear of retaliation; ensure proper reporting of violation or potential violations including potential fraud or misconduct to duly authorized enforcement agencies as appropriate and/or required

  • Work closely with Internal Audit and NCO-NSIU whenever applicable; where/when applicable and appropriate, coordinate with Medicare Fraud Control Units (MCFUs), commercial payers, and other organizations when a FW&A issue is discovered to involve multiple parties.

  • Oversee and ensure the integrity of the regional hotline process

  • Ensure that shared service and/or nationally managed functions meet regional compliance accountabilities.

Basic Qualifications:

Experience

  • Minimum ten (10) years of escalating responsibility and work experience in a compliance field (internal audit,law, etc.) to include progressive management roles in large, complex organization with successive levels of accountability and results.

  • Minimum ten (10) years of escalating managerial work experience in a highly diversified organization.

Education

  • Bachelor-s degree in a related field (health care, business, etc.)

License, Certification, Registration

  • N/A

Additional Requirements:

  • Significant compliance orientation, coupled with business process expertise and acumen.

  • Demonstrated knowledge of current thinking and practice around the business of compliance.

  • Significant knowledge of all pertinent regulatory requirements and compliance program elements

  • Demonstrated ability to collaborate, communicate and work effectively with senior leadership and a broad cross section of management/leadership from a broad range of functional areas.Demonstrated ability to influence and motivate interdisciplinary teams and individuals who do not report directly to the CCO.

  • Demonstrated expertise in organizational development, project management, and strategic planning

  • Superior communications skills (both oral and written)

  • Demonstrated high ethics and integrity

  • This position consistently supports compliance and the Principles of Responsibility (Kaiser Permanente-s Code of Conduct) by maintaining the privacy and confidentiality of information,protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations,accreditation and licensure requirements (if applicable), and Kaiser Permanente-s policies and procedures.

Preferred Qualifications:

  • KP experience preferred.

  • Master's degree preferred.

COMPANY: KAISER

TITLE: Regional Compliance Officer - KPNW

LOCATION: ,

REQNUMBER: 682353

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.