Director, Compliance (Nevada Health Plan) - Remote in Nevada

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Job Description

Leads and directs team responsible for compliance activities. Seeks to ensure the organization adheres to regulatory requirements, industry standards, and Molina internal policies, and prevents and/or detects violation of applicable laws and regulations, and protect the business from liability, fraudulent or abusive practices.

Essential Job Duties

• Directs and oversees compliance activities and serves as a resource on compliance issues.
• Demonstrates leadership and expertise to ensure compliance with applicable state/federal statutes and internal policies.
• Facilitates training and education, and subject matter expertise related to compliance requirements.
• Ensures business accountability for compliance investigations - ensuring oversight, follow-up, and resolution.
• Enforces the compliance plan, code of conduct and anti-fraud plan.
• In conjunction with compliance leadership and the special investigative unit (SIU) team, develops an active relationship with third parties who have specific experience in conducting fraud, waste and abuse (FWA) investigations.
• Prepares written quarterly reports to inform compliance leadership on the status of activities pertaining to overall compliance for area(s) of responsibility.
• Oversees team of compliance professionals; responsible for hiring, performance management, recognition, and staff development. Job Requirements
• At least 8 years of experience in compliance, risk management, and/or auditing, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Extensive knowledge of relevant regulatory frameworks and industry standards.
• Experience developing and implementing compliance programs and controls.
• Strong leadership, strategic thinking, and decision-making capabilities.
• Ability to thrive in a cross-functional highly matrixed environment.
• Strong analytical and problem-solving skills.
• Project management experience.
• Ability to build rapport and gain the respect and collaboration of internal/external stakeholders.
• Knowledge and ability to think creatively, proactively, and independently.
• Ability to prepare reports and presentations and manage data.
• Self-motivated and results oriented.
• Strong organizational skills and the ability to meet delivery targets.
• Disciplined and ability to effectively track, document and report on projects/activities.
• Strong verbal and written communication skills.
• Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications
• Previous experience in a health plan or government programs setting (Medicaid, Medicare, Marketplace).
• Certificate in Healthcare Compliance (CHC), or other compliance-related certification.
  
  

To all current Molina employees. If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $102,163 - $199,219 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
  
  

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