AIDS Healthcare Foundation

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Contract Compliance Manager

Contract Compliance Manager

Req No 
2017-7141
Job Locations 
US-FL-Fort Lauderdale
Category 
Managed Care
Type 
Regular Full-Time

More information about this job

WHO WE ARE

AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE at AIDS Healthcare Foundation!

 

Does the idea of doing something that really makes a difference in people’s lives while being well-compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees?

 

If so, AIDS Healthcare Foundation is the place for you!

 

Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them.

  

AHF’s core values are:

 

• Patient-Centered

• Value Employees

• Respect for Diversity

• Nimble

• Fight for What’s Right

 

The CME Coordinator is responsible for projecting and integrating the Mission and Core Values of the organization within and outside of the Department of Medicine.


Summary:    
This position shall execute the process of coordinating all aspects of Continuing Medical Education (CME) programs for physicians and other providers.  Maintain documentation of all educational activities according to the ACCME. Remain current on all CME  rules and guidelines of the ACCME.  

 

STILL INTERESTED? Please continue!

YOUR CONTRIBUTION TO OUR SUCCESS!

YOUR CONTRIBUTION TO OUR SUCCESS!

 

The Contract Compliance Manager is a key leader in AHF’s Managed Care Division and health plans, PHP and PHC.  This leadership position helps the health plans remain complaint with its regulatory contracts and serves as the principal liaison between the health plan and the federal and/or state regulator.  By building a stronger relationship between the plan and regulator, the Contract Compliance Manager positions the health plans to grow and retain membership.

 

The Contract Compliance Manager also serves as a project manager.  This position works with health plan directors and executives to respond to various requests from our regulators, including financial reports, operations reports, statutory requirements, and contract submission requirements.   

 

The Contract Compliance Manager helps each health pan department meet its contracted obligations by working with them to communicate and interpret contract terms and statutory requirements.  This is accomplished by ongoing meetings, reports, monitoring, action plans, and contract updates.   

 

BENEFITS AT AHF
AHF offers comprehensive benefits to help our employees do and be their very best! These benefits are intended to enhance employee physical, financial, spiritual, and professional health.

 

Essential Duties & Responsibilities
Includes the following.  Other duties may be assigned.

  • Develops and maintains an expert level knowledge base of the managed care contract, reporting requirements and standards, state and federal regulatory requirements and health plan accreditation standards.  Works collaboratively with MCO executive management, business unit directors and staff to assure contract execution is timely, effective and efficient.
  • Develops and maintains a strong business relationship with the client.  Communicates effectively with client’s leaders which may include AHCA contract manager and other regulatory leaders.
  • Represent plan at client meetings and communicate information to relevant parties within the plan and executive management.
  • Manage internal projects related to implementation, maintenance, and renewal of client contract.  This will include preparing project management tools, working with internal departments to complete projects, and ensuring timely completion and submission
  • Develop and maintain a detailed work plan for contract execution, monitoring and milestone attainment that is sufficient in nature to clearly outline departmental and individual Director responsibilities.  Communicates contract requirements to business unit directors in a clear and concise manner.
  • Prepares formal reports of contract work plan progress and accomplishments to the Chief and VP of Managed Care no less than quarterly.
  • Works with Compliance Department to identify required reports and submissions and ensuring the responsible departments prepare and submit them accurately and on time
  • Assist with management and preparation of relevant policies and procedures
  • Conduct periodic assessments to ensure compliance against contract requirements
  • Oversee creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies
  • Coordinate and oversee all contract audit preparation, execution and follow-up activities.
  • Collaborate with Health Plans and States, where applicable, to maintain/improve customer satisfaction specific to delegated functions and compliance with contract requirement.
  • Manage composition and delivery of responses to state regulatory agency complaints and inquiries
  • Design, implement and improve processes to prevent, detect and respond to contract compliance issues and concerns related to all federal and state regulatory requirements and contract requirements.
  • Create and deliver contract compliance training for all employees on an annual basis and as needed basis, such as in response to a compliance issue or concern

Education and/or Experience
Bachelor’s degree (B.A.) from four-year college or university; or one to two years related experience and/or training or equivalent combination of education and experience.  Prior managed care experience preferred

Other Skills & Abilities/Qualifications
Bachelor’s degree in Health Services/ Health Administration or related field preferred.
Masters degree preferred.
Must be able to travel at least 30% of the time.

Certificates, Licenses and Registrations
Current FL driver’s license with proof of liability insurance.


We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment.