JOB SUMMARY: The Manager, Compliance - STAR+PLUS will be responsible for the daily management and oversight of the HHSC STAR+PLUS program to ensure compliance with applicable laws, regulations, and contractual requirements. Specifically, this position will require in-depth knowledge of STAR+PLUS including developing and establishing policies and procedures to comply with this Medicaid managed care program for adults with complex medical needs. This position will be responsible for providing leadership, guidance, and education company-wide to ensure compliance/accuracy with policies, procedures, and deliverables related to STAR+PLUS. Strong collaboration, communication, and interpersonal skills are required.
JOB SPECIFICATIONS AND CORE COMPETENCIES:
Compliance lead for developing, implementing, and evaluating company-wide effectiveness of STAR+PLUS program related functions
Develop, implement, and manage Compliance policies and procedures for STAR+PLUS and collaborate with the Policies and Procedures team to ensure accuracy of regulatory requirements and citations. Timely and accurately communicate compliance-related information to operational areas, Director, and Chief Compliance Officer.
Develop training material and conduct internal / external stakeholder training sessions as necessary.
Collaborate with internal operational areas on matters related to regulatory reporting, audits, and corrective action plans related to STAR+PLUS.
Analyze and evaluate information related to the healthcare regulatory environment by monitoring appropriate state, federal and industry channels, and participating in workgroups as applicable. Monitor and assess compliance risks with state and federal regulations related to STAR+PLUS and develop strategies to mitigate risks.
Education/Specialized Training/Licensure: Bachelors degree in healthcare administration, business administration or related field required. Masters degree in business or healthcare related field preferred.
Work Experience (Years and Area): 5-7 years of experience in healthcare compliance, with a focus on the STAR+PLUS program and managed care required. Experience working with regulatory agencies preferred.
Management Experience (Years and Area): Minimum of 2 years of management, supervisory experience, leading projects and conducting training required.
The Harris Health System is a fully integrated healthcare system that cares for all residents of Harris County, Texas. We are the first accredited healthcare institution in Harris County to be designated by the National Committee for Quality Assurance as a Patient-Centered Medical Home, and are one of the largest systems in the country to achieve the quality standard. Our system includes 23 community health centers, five school-based clinics, a dental center and dialysis center, mobile health units, a rehabilitation and specialty hospital and two full-service hospitals.Ben Taub Hospital is a world renowned Level I Trauma Center with 586 licensed acute-care beds and provides a wide range of specialty care outpatient services. Lyndon B. Johnson Hospital is a 328 licensed bed acute-care hospital with a newly expanded Level III trauma center and a distinguished regional center for neonatal intensive care for high-risk deliveries.Harris Health is a teaching system for Baylor College of Medicine and The University of Texas Health Science Center at Houston (UTHealth). We train the next generation of healthcare providers on the latest medical procedures and technological breakthroughs.With... our fully integrated electronic medical records system, we offer patients the convenience and assurance that their medical history is accurate, safe and available when and where it is needed. Our Medical Home designation ensures that we offer a full range of preventive, specialty and acute care services for the entire family.