Sr. Director, Compliance

Position: Sr. Director, Compliance

The Sr. Director, Compliance is an experienced compliance professional that plays an integral role in the effectiveness of Monogram Health's Compliance Program. This individual applies their compliance, regulatory, clinical, and business acumen to ensure compliance with federal and state laws, regulations, and other applicable requirements (including, but not limited to Medicare and Medicaid rules and regulations).

Roles and Responsibilities

• Implements, administers, and oversees various aspects of the Compliance Program to promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect and mitigate compliance risks.
• Monitors the performance of the Compliance Program and related activities on an ongoing basis and takes appropriate steps to improve its effectiveness.
• Develops, coordinates, and participates in an effective compliance training program for new and existing employees and as required for non-employees (e.g., Board Members, Downstream Entities).
• Provides strategic compliance guidance to organizational areas with respect to laws, regulations and other applicable requirements.
• In consultation with the Chief Compliance Officer and General Counsel, investigates and acts on matters related to compliance, including the flexibility to design and coordinate internal investigations and any resulting corrective action, working with the Human Resources as appropriate.
• In consultation with the Chief Compliance Officer and General Counsel, ensures the proper reporting of violations or potential violations to the duly authorized enforcement agencies as appropriate or required.
• Develops policies and procedures and programs designed to encourage individuals to report compliance concerns without fear of retaliation.
• Oversees the compliance hotline, reporting, documentation, and investigation of compliance related issues.
• Develops and implements strategic goals related to Compliance effectiveness and improvement, Compliance related risk assessments, auditing and monitoring, and training.
• Performs or directs through one or more designees, monitoring, auditing and other oversight activities of operational areas/functions, including activities delegated to First Tier, Downstream, and Related Entities (FDRs).
• Works with Operational Departments to ensure that policies and procedures are developed and modified to comply with Medicare, Medicaid, federal, and state regulatory standards. Provides guidance, in consultation with Legal Department (as appropriate), to various departments with respect to regulatory and contract language.
• Ensures routine exclusion and sanction monitoring is performed for all Monogram Health employees, contractors, and vendors to ensure licensure status and compliance with federal, state, and payor standards. Works with the Human Resources Director to investigate discovered concerns.

Position Requirements

• Bachelor's degree Healthcare Administration, Business Administration, or related field or equivalent experience required. Master's degree Healthcare Administration, Business Administration, or related field preferred.
• 7+ years of Medicare Managed Care compliance experience required, ideally with expertise in Special Needs Plan Model of Care (SNP MOC) requirements.
• A current Registered Nurse (RN) license is highly preferred.
• 1+ years Overseeing implementation of contract requirements, required.
• 5+ years of experience in a leadership role required.
• Personal Characteristics: Detail oriented, able to work in a fast-paced environment, able to handle confidential information.
• Certifications and licenses: Must possess or obtain within 1 year of employment, Certification in Healthcare Compliance (CHC) by the national Healthcare Compliance Association (HCCA).

Benefits

• Opportunity to work in a dynamic, fast-paced and innovative value-based provider organization that is transforming the delivery of kidney care
• Competitive salary
• Comprehensive medical, dental, vision and life insurance
• Flexible paid leave and vacation policy
• 401(k) plan with matching contributions

About Monogram Health

Monogram Health is a next-generation, value-based chronic condition risk provider serving patients living with chronic kidney and end-stage renal disease and their related metabolic disorders. Monogram seeks to fill systemic gaps and transform the way nephrology, primary care and chronic condition treatment are delivered. Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum. By focusing on increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and improving health outcomes for individuals with chronic kidney and end-stage renal disease.

At Monogram Health we believe in fostering an inclusive environment in which employees feel encouraged to share their unique perspectives, leverage their strengths, and act authentically. We know that diverse teams are strong teams, and welcome those from all backgrounds and varying experiences.