Hybrid Vice President Chief Compliance Officer bei AmeriHealth Caritas

Job Summary

Reporting to the Chief Risk Officer, the Vice President, and Compliance will lead a compliance program that supports the organization’s solutions and products, including the rapidly growing Medicaid platform as well as Medicare and plans in the Exchange. The Vice President, Compliance will serve in a leadership role within AmeriHealth Caritas, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. They will work with ERM and internal audit to think holistically about the risk profile and risk mitigation for AmeriHealth Caritas. The position ensures the Board of Directors, management and employees are in compliance with the rules and regulations of regulatory agencies, that AmeriHealth Caritas policies and procedures are being followed, and that behavior in the organization meets AmeriHealth Caritas’ Code of Conduct.

Work Arrangement

This position is a hybrid position 2-3 days a week in our Newtown Square, PA office.  

Key Responsibilities

• Continues the development of a comprehensive, enterprise-wide compliance program that meets the expectations of State and Federal regulatory requirements and guidance, and ensures that policies and procedures are monitored, audited and enforced.
• Develops and implements a Regulatory Change Management Program to ensure any new state or federal regulations are evaluated, communicated to the impacted areas, processes are implemented to comply with new requirements, and controls are implemented to ensure sustained compliance.
• Oversees the Company’s Compliance, Ethics, Privacy, and Fraud Waste and Abuse Programs.
• Periodically reviews and updates the Code of Conduct and the Conflict of Interest policy to ensure continuing currency and relevance in providing guidance to Board and Committee members, management and employees.
• Develops and oversees the implementation and maintenance of operational controls, and programs for reconciliation and integrity of the reporting of organizational data.
• Acts as an independent review and evaluation body to ensure that compliance issues / concerns within the organization are being appropriately evaluated, investigated and resolved. Collaborates with other departments (e.g. HR, Internal Audit, ERM) to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with the Office of the Chief Legal Officer as needed to resolve legal compliance issues.
• Responds to alleged violations of rules, regulations, policies, procedures, and the Code of Conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations.
• Monitors, and, as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
• Identifies potential areas of compliance vulnerability and risk; develops / implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future. 
• Provides reports on a regular basis, and as directed or requested, to keep the Audit and Compliance Committee and senior management informed of the operation and progress of compliance efforts.
• Monitors key performance and risk indicators/metrics to assist with the early identification of risk trends across various operational units. 
• Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of the Code of Conduct and the Conflict of Interest policy, and (c) understanding of new and existing compliance issues and related policies and procedures. 
• Works with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees. 
• Assures that compliance policies and procedures are communicated throughout the company. 
• Participates and coordinates the external compliance audits from entities providing oversight. 
• Directs and coordinates compliance and regulatory performance initiatives in alignment with organizational strategic goals and objectives. 
• Initiates, oversees, and integrates a comprehensive member-centric compliance program as a component to maintain or enhance the privacy of member information.

Education/Experience:

• Master’s Degree § Advanced degree (Juris Doctor degree and/or Master’s Degree in healthcare or business-related field) preferred, but not required.
• Significant experience with effectively making presentations to Boards, Committees and senior leadership is required. 
• Familiarity with operational, financial, analytics, quality assurance, audit and human resource procedures.
• Ten or more year’s at least ten years of experience in healthcare environment including experience in MA managed care and extensive experience working in performance improvement and compliance areas.

Other Skills:

Setting Strategy

• The ability to create and articulate an inspiring vision for the organization, not only for the areas s/he is directly responsible for, but the enterprise as a whole.
• The inclination to seek and analyze data from a variety of sources to support decisions and to align others with the organization's overall strategy.
• An entrepreneurial and creative approach to developing new, innovative ideas that will stretch the organization and push the boundaries within the industry.
• The ability to effectively balance the desire/need for broad change with an understanding of how much change the organization is capable of handling, to create realistic goals and implementation plans that are achievable and successful.

Executing for Results 

• The ability to set clear and challenging goals while committing the organization to improved performance; tenacious and accountable in driving results. 
• Comfortable with ambiguity and uncertainty; the ability to adapt nimbly and lead others through complex situations. 
• A risk-taker who seeks data and input from others to foresee possible threats or unintended circumstances from decisions; someone who takes smart risks.
• A leader who is viewed by others as having a high degree of integrity and forethought in his/her approach to making decisions; the ability to act in a transparent and consistent manner while always taking into account what is best for the organization.

Leading Teams 

• The ability to attract and recruit top talent, motivate the team, delegate effectively, celebrate diversity within the team, and manage performance; widely viewed as a strong developer of others.
• The ability to persevere in the face of challenges, and exhibit a steadfast resolve and relentless commitment to higher standards, which commands respect from followers. 
• A leader who is self-reflective and aware of his/her own limitations; leads by example and drives the organization's performance with an attitude of continuous improvement by being open to feedback and self-improvement.

Relationships and Influence 

• Naturally connects and builds strong relationships with others, demonstrating strong emotional intelligence and an ability to communicate clearly and persuasively.
• An ability to inspire trust and followership in others through compelling influence, powerful charisma, passion in his/her beliefs, and active drive. Encourages others to share the spotlight and visibly celebrates and supports the success of the team.
• Creates a sense of purpose/meaning for the team that generates followership beyond his/her own personality and engages others to the greater purpose for the organization as a whole.

Driving Sustainability 

• Firmly believes that both sustainability and profit are in the organization’s best long-term interest. 
• Integrates economic, societal, and environmental factors into a purpose-driven strategy, turning sustainability into a competitive advantage.
• Understands and incorporates viewpoints from all key stakeholders to drive decision making and share the benefits. 
• Delivers breakthrough innovations and business models that create value for all stakeholders, continually challenging traditional approaches. 
• Sets audacious business and sustainability goals, driving concerted action and investments, and stays the course in the face of setbacks or push-back from short-term oriented stakeholders.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.