DHMP Compliance Manager

We are recruiting for a DHMP Compliance Manager to join our team!

We are here for life's journey.

Where is your life journey taking you?

Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all :

Humanity in action, Triumph in hardship, Transformation in health.

Department

Enterprise Compliance Services

Job Summary

The Manager of Compliance DHMP works closely with the Denver Health Chief Compliance and Audit Officer and Health Plan leadership to meet the compliance function needs for Denver Health Medical Plan (DHMP).

The Manager oversees DHMP Compliance Analysts and leads the team to provide requested guidance on requirements from the Centers for Medicare & Medicaid Services (CMS), the Colorado Department of Healthcare Policy and Financing (HCPF), the Colorado Department of Insurance (DOI), and other government agencies who oversee health plans and other healthcare organizations.

The Manager participates and assists the Compliance Department in meeting all compliance needs, including writing policies, conducting investigations, conducting an annual risk assessment, and creating an annual work plan to audit and monitor DHMPs operational areas to ensure compliance with state and federal requirements.

The manager works closely with DHMP leaders, including executives, and reports compliance activities and concerns on a regular basis.

Essential Functions :

Operations Management

Direct and assist with regulatory audits, investigations, and projects. (20%)

Strategy and Planning

Collaborate with key stakeholders to assist in establishing and implementing short and long-term priorities in alignment with the strategic objectives of DHMP.

Regularly assess organizational needs, understand the context and drivers of a changing workforce to inform new organizational initiatives that enable staff to develop the assets and skills needed for success.

Make recommendations and drive consensus for the achievement of such initiatives. Participate in the institution wide development of the annual work plan. (15%)

Advisory Services

Research and respond to inquires from other departments and leaders regarding health plan requirements and offer meaningful solutions to DHMP concerns that align with and are within regulatory requirement and guidelines.

15%)

Audit and Compliance

Plan, direct, and conduct audits to evaluate the adequacy and accuracy of health plan and compliance functions to ensure that DHMP is meeting requirements from multiple government agencies and other stakeholders. (15%)

Policy and Procedures

Establish, lead implement and maintain compliance policies, procedures, audit methods, standards, and tools. (15%)

Investigations

Independently plan, conduct and perform investigations on matters related to compliance, including developing investigation plans and coordinating investigations and any resulting corrective action with departments and business associates. (10%)

Staff Management

Oversee the activities of the staff which includes but is not limited to sourcing, hiring, and training new team members, evaluating performance, and providing coaching to engage and motivate team members, identifying and applying career advancement opportunities for team members, and helping to resolve employee issues and disputes. (10%)

Education :

Bachelor's Degree Required

Work Experience :

• 4-6 years Health Plan / Healthcare Compliance or Compliance Related Roles Required and
• 1-3 years Leadership and / or Supervisor Roles Required

Licenses :

Knowledge, Skills and Abilities :

• Knowledge of Medicare, Medicaid, and commercial health plan requirements and general compliance requirements
• Knowledge of general health plan operations including finance, billing / claims processing, and member and provider relations.
• Objectively evaluate, analyze, and operationalize requirements and limitations.
• Develop and maintain internal and external professional relationships through communication, negotiation, and conflict resolution.
• Leadership skills necessary to lead, motivate, and engage a team of direct reports and other throughout DHMP
• Proficient in Microsoft Office Suite and otherwise computer literate.
• Strong oral and written communication, including comfort presenting to large groups.

Shift

Work Type

Regular

Salary

$104, - $157, / yr

Benefits

Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to , and generous medical plans

Free RTD EcoPass (public transportation)

On-site employee fitness center and wellness classes

Childcare discount programs & exclusive perks on large brands, travel, and more

Tuition reimbursement & assistance

Education & development opportunities including career pathways and coaching

Professional clinical advancement program & shared governance

Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF programÂ

National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

Respect

Belonging

Accountability

Transparency

Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit :