Provider Services Compliance Manager - RN

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time offand 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

* Manages day to day functions of the Corporate, Provider, and VNS Health Plans Compliance Programs.

* Audits and monitors activities in accordance with the Compliance Work plan; prepares summary reports for leadership.

* Conducts investigations of allegations or reports of fraud, waste and abuse and/or privacy violations under the direction of compliance and legal counsel leadership, as appropriate.

* Provides education and training to enterprise staff on compliance related issues.

* Collaborates with leadership in developing, reviewing, and revising compliance policies, procedures and related activities for the enterprise. Ensures that enterprise staff are aware of and in compliance with policies and procedures.

* Collaborates with operations to implement corrective actions and implement controls related to identified compliance concerns; evaluates the efficacy of the controls.

* Reviews data for patterns and/or trends that may indicate workstream or process concerns involving errors or quality related issues. Prepares reports to communicate key patterns and/or trends and their implications from a compliance/risk perspective.

* Provides recommendations to address the identified concerns and follows-up with any implemented changes.

* Utilizes data to develop process improvement recommendations. Ensures that regulatory changes or other updates are incorporated into process flows and that concerns are resolved across the appropriate process teams.

Collaborates with Human Resources and enterprise leadership to ensure consistency of disciplinary actions related to matters of non-compliance, especially those related to fraud, waste and abuse and privacy violations.

* Assists with responses to external requests including, but not limited to, government audits and record requests from oversight agencies.

* Communicates with state and federal regulators in seeking guidance, responding to inquiries and implementing regulatory updates.

* Creates an environment that encourages the reporting of compliance concerns and allegations.

* Keeps up to date regarding compliance and privacy laws, regulations and trends for all VNS Health entities and programs. Serves as a resource to staff with regard to compliance related matters and questions.

* Collaborates with the Risk Department to conduct an Annual Risk Assessment, and to develop and implement an Annual Corporate and Provider Compliance Work plan.

* Participates in special projects and performs other duties as assigned.

Licenses and Certifications:
Professional license and current registration to practice as a Registered Nurse in New York State required. Compliance certification preferred

Education:
Bachelor's or master's degree required based on current licensure required

Work Experience:

• Minimum of four years of progressive experience in a health care compliance environment required
• Demonstrated knowledge of federal and state health care compliance laws, regulations and requirements required
• Knowledge and experience with compliance requirements applicable to VNSNY provider and community benefit programs preferred
• Strong written and verbal communication, as well as interpersonal and management skills required