Compliance Lead, Vendor Oversight
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: The Compliance Lead for Vendor Oversight is responsible for administration and monitoring of Medicaid and Medicare Advantage products for contract compliance. This individual will have an active and engaged role in monitoring Delegated Vendors Oversight (DVO) and First Tier Downstream/Related Entities (FDR) for Steward Health Care Network (SHCN).
- Ensure compliance with state and federal laws, regulations, mandates, and contract requirements.
- Monitors delegated vendor relationships with the responsibility for ensuring contractual requirements and performance service levels of delegated functions are adhered to in a compliant manner.
- Maintain and track whether the subcontractors submit timely and accurate deliverables required by state and federal regulations including both routine/recurring reports and ad hoc requests.
- Drives compliant resolution of all vendor issues, including vendor communications and reporting.
- Monitor, confirm, and document contractor performance through completion of: Pre-delegation audits; Regular attendance of Joint Operating Committees (JOC) and DVO committees; Routine and recurring subcontractor performance reports; Periodic reviews and annual audits; Documented corrective action plans
- Conducts auditing and monitoring activities in connection with subcontractor oversight and the ongoing risk assessment component of the compliance program which identifies areas of focus- based operational performance and evolving legal, contractual, and regulatory requirements.
- Drives ongoing process improvement to deliver increasing vendor quality, compliance, and efficiency in all vendor related processes.
- Interfaces with SHCN management which may include Corporate and Health Plan matrix partners in order to ensure contractual obligations are achieved.
- Collaborates with functional areas to ensure vendors provide compliant day to day operations of SHCN policies and procedures which brings quality and value to the network.
- Maintains highly effective working relationships with vendors and internal matrix partners in order to improve vendor performance.
- Develops and maintains approved vendor document library.
- Develop communications and training, including policies and procedures, state and federal laws, regulations, and contract requirements.
- Serve as Steward Lead with regulators for all contract compliance matters, including meetings with designated oversight personnel from regulators.
- Report to program governance regarding compliance activity.
- Bachelor’s degree required.
Years of Experience:
- 3+ years of compliance experience.
- Experience with managed care required; experience with Medicaid managed care preferred
- Experience proposing improvements through the coordination and documentation of Delegated Vendor Oversight Committee activities
- Demonstrates knowledge of managed care concepts for various health plan and capitated program.
- Ability to work as part of a team and collaborate with colleagues in a highly matrixed environment