Job Description

Steward Health Choice is dedicated to improving the health and well-being of the people and communities we serve.

Steward Health Choice believes in a personal approach to health care right in your community. We built our health care plan around you. Our goal is to give you quality health care, programs, and services to support you on your path to wellness.

Steward Health Choice provides exceptional customer service and culturally competent care through:

  • Compassionate and responsive member services team
  • Collaboration with community physicians to help members get the health care they need.
  • Providing culturally competent health care, including extensive translation and interpretation services
  • Health programs to help members and their families stay healthy

Position Purpose: This individual has overall responsibility to ensure the Health Plan meets the regulatory, administrative, and legal requirements set forth by the Utah Department of Insurance and as defined under the agreement with the Utah Department of Health. This individual has overall responsibility to ensure 100% compliance with requirements through daily Health Plan oversight, monitoring, and engagement through ad hoc and routine audits and reviews.

  • Serve as the primary point of contact for the Utah Department of Health including required oversight of contract deliverables, renewal, and maintenance. This individual is required to serve as a liaison for the organizational deliverables that are routinely reported.
  • Oversee the regulatory requirements for the HMO license held with the Utah Department of Insurance including providing the necessary filings in cooperation with legal, finance, and other operational departments.
  • Ensure routine and ad hoc reports are filed timely and accurately with regulators
  • Ensure ad hoc requests for information or analysis is responded to timely and accurately
  • Oversee the preparation, management, and serve as the primary contact for regulatory audits including EQRO, DOI tri-ennial financial exam, and submission of annual quality improvement activities.
  • Manage the organization response to required corrective action plans including organizing the analysis and development of ongoing resolution plans – including monitoring activities to ensure ongoing compliance
  • Serve as the senior subject matter expert on DOI and UDOH contract regulations
  • Participate as a senior leader in meetings with the DOI and UDOH to manage and direct the daily operations of the health plan
  • Facilitate internal vendor contract review and compliance
  • Responsible for local privacy / HIPAA compliance including conducting routine compliance walk arounds noting infractions for specific employees
  • Maintain strong partnerships with colleagues at the DOI and UDOH serving as the primary point of contact / liaison for all activities
  • Oversee and provide daily management for local compliance monitoring activities included using the necessary software tools necessary to track deliverables, responsible parties, due dates, and progress. This may include facilitating readiness reviews and ensuring the overall organizational response.

Education:

  • Bachelors Degree in business, finance, or accounting.
  • Masters Degree in business, finance, or accounting preferred.

Years of Experience:

  • 10+ years of progressively more responsible leadership experience in Health Plan compliance or insurance regulation.
  • Internal risk and control audit experience.
  • Experience with privacy and information security compliance.

Specialized Knowledge:

  • Prior experience serving in an internal insurance audit / compliance role
  • Government program (Medicare and Medicaid) experience
  • Compliance certifications
  • Internal audit certifications
  • Project Management Certification (CPMP)

Application Instructions

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