AmeriHealth Caritas Director Compliance & Regulatory Affairs in Baton Rouge, Louisiana

Director Compliance & Regulatory Affairs

Location: Baton Rouge, LA

Telecommuter?: No

ID**: 14431

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .

Responsibilities:

Under the general direction of the Market President, the Director of Compliance and Regulatory Affairs,provides strategic advice and guidance for achieving ACFC goals and objectives while complying with the contract requirements and Medicaid regulations for both physical health and behavioral health managed care business. The Director is responsible for the development and implementation of a Compliance Program for LA physical health managed care business to ensure compliance with key business requirements and to minimize risk issues. The Director also provides strategic guidance to the implementation of policy and initiatives in response to emerging federal health care policy.

The Director, LA Compliance and Regulatory Affairs, manages the annual LDH contract amendment process, facilitating timely review and comment and maintaining appropriate change control procedures. The Director Compliance & Regulatory Affairs will serve as the primary point-of-contact for all contract compliance issues, will manage the connection of MCO personnel to LDH business owners, and will develop and implement written policies, procedures, and standards to ensure compliance with the requirements of this contract. These functions may include but are not limited to coordinating the tracking and submission of all contract deliverables; fielding and coordinating responses to LDH inquiries, coordinating the preparation and execution of contract requirements, random and periodic audits and ad hoc visits. This position shall report directly to the CEO and board of directors in accordance with 42 CFR §438.608(a)(1)(ii).

The Director Compliance and Regulatory Affairs will assist the Market President with the development and execution of departmental strategic planning and budget activities. He/she directs the administrative functions for the Baton Rouge Government Affairs Office and provides information and recommendations to the Market President on matters that may impact departmental goals and the budget. The Director directly manages a team of professional and management level Associates and supports the development of highly skilled and knowledgeable Associates. The Director Compliance & Regulatory Affairs represents the Market President in his/her absence.

The Director, LA Compliance and Regulatory Affairs operates independently with minimal management oversight, and is able to manage competing priorities and deadlines that are subject to frequent change. He/she must possess and exercise excellent professional judgment in all interactions.

Education/Experience:

  • Five plus years’ management experience in Healthcare/Insurance, preferably in Medicaid Managed Care.

EOE Minorities/Females/Protected Veterans/Disabled