Sr. Director, Third Party Compliance Oversight

Why This Role is Important to Us

The Senior Director, Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and Risk Operations, and leads the Third-Party Compliance Oversight department for Commonwealth Care Alliance (CCA). This position effectively leads our Third-Party Compliance Oversight programs which includes monitoring and evaluating the performance of delegated third parties according to CMS, federal, and state requirements in a manner that continually supports the business and operational areas.

What You'll Be Doing

• Strategically leads the Third-Party Compliance Oversight Department staff that perform compliance oversight and monitoring of delegated third parties including Medicare FDR; Duals / SNP; and Medicaid / LTSS programs.
• Coordinates and reviews work completed by Third-Party Compliance staff including risk assessments, compliance program reviews, pre-delegation screenings and various items for
• accuracy and completeness.
• Manages and monitors third parties against CMS, contractual, federal, and state requirements.
• Ensures strategic and operational partnership and collaboration with the business and operational areas, as well as with GRC teams to leverage cross-departmental synergies and efficiencies.
• Maintains strong communication and working relationships with internal and external business partners.
• Develops clear, effective, and timely reports and updates for senior management and / or the Board regarding Third-party Oversight Compliance Program effectiveness, initiatives, and issues, including all relevant metrics, dashboards and information.
• Reviews, researches, interprets and summarizes federal and state regulations and ensures timely training of key personnel impacted by new or changed regulations.
• Facilitates and participates in team and committee meetings, providing ideas and suggestions to ensure compliance standards are met.
• Assesses, investigate, and resolve issues to ensure customer satisfaction.
• Maintains a positive work environment and supports the experience, skill, knowledge, and growth opportunities of all employees.
• Coordinates and performs on-going monitoring of third-party activities to ensure compliance.
• Works closely with the Governance, Risk & Compliance (GRC) teams (Medicare, Medicaid, Privacy, Fraud, Waste & Abuse) for dissemination of new or revised requirements applicable to the delegated third-party.
• Oversees, develops, and maintains reporting and metrics for delegated third-party activities.
• Ensures timely receipt of accurate and complete reporting for all regulatory and contractually required reports for delegated third parties.
• Oversees the process for completing Third-Party Pre-Qualification / Delegation Assessments.
• Oversees the process for Third-Party Annual Attestations.
• Oversees and conducts risk assessments for each third-party.
• Develops and maintains oversight document evidence related to compliance oversight in preparation for state, federal and regulatory audits.
• Monitors and audits delegated third parties to ensure compliance with state and federal requirements.
• Executes compliance monitoring plans to monitor delegated third parties to meet regulatory oversight and compliance requirements.
• Oversees, develops, assesses, and adapts clear and effective remediation and corrective action initiatives, protocols, and controls to ensure proper and timely compliance.
• Stays 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 laws, regulations, contractual requirements, industry standards and best practices.
• Performs other duties as assigned.