Utilization Management Director, Compliance

Kaiser Permanente

Atlanta, GA

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JOB DETAILS

SALARY

$163,500–$211,530 Per Year

SKILLS

Analysis Skills, Benchmarking, Best Practices, Business Analysis, Business Plan, Business Strategy, Business Support, Contact Management, Contingency Plans, Corporate Compliance, Corrective Action, Cost Analysis, Cost Forecasting, Cross-Functional, Detail Oriented, Diversity, Financial Audit, Financial Management, Financial Regulations, Forecasting, Functional Programming Languages, Health Plan, Healthcare, Healthcare Administration, Healthcare Quality, Hospital, Hospital/Healthcare Construction, Industry/Trade Analysis, Information/Data Security (InfoSec), Insurance, Interviewing Skills, Leadership, Legal, Maintain Compliance, Medical Office, Needs Assessment, Negotiation Skills, People Management, Performance Management, Policy Development, Policy Implementation, Problem Solving Skills, Program Planning, Project/Program Management, Public Health, Public Policy, Qualitative Analysis, Quantitative Analysis, Regulations, Regulatory Compliance, Risk, Risk Management, Schedule Development, Standards Development, Talent Management, Team Building, Team Player, Utilization Management

LOCATION

Atlanta, GA

POSTED

Today

Job Summary:
Health plan utilization management compliance experience. This director level position is primarily responsible for overseeing company compliance activities including designing strategies for the implementation of regulatory changes. Responsibilities include directing compliance reporting efforts, compliance investigation, and activities associated with continued regulatory compliance across multiple business functions. Additional key responsibilities include directing and overseeing the implementation of compliance efforts through approving requirements and monitoring ongoing compliance adherence. This managing level employee also directs programs or compliance components of larger cross-functional programs including identifying and managing stakeholders.

Essential Responsibilities:

Demonstrates continuous learning and maintains a highly skilled and engaged workforce by aligning resource plans with business objectives; overseeing the recruitment, selection, and development of talent; motivating teams; preparing individuals for growth opportunities and advancement; staying current with industry trends, benchmarks, and best practices; providing guidance when difficult decisions need to be made; and ensuring performance management guidelines and expectations drive business needs.
Oversees the operation of multiple units and/or departments by identifying customer and operational needs; analyzing resources, costs, and forecasts and incorporating them into business plans; gaining cross-functional support for business plans and priorities; translating business strategy into actionable business requirements; obtaining and distributing resources; setting standards and measuring progress; removing obstacles that impact performance; guiding performance and developing contingency plans accordingly; and ensuring products and/or services meet customer requirements and expectations while aligning with organizational strategies.
Oversees company compliance activities by ensuring team members, including external business partners, provide support to internal and external stakeholders; reviewing and approving compliance activities; designing strategies for the implementation of regulations and regulatory changes; ensuring compliance activities are fully documented; and overseeing the resolution of compliance issues.
Directs compliance reporting efforts across multiple business functions by overseeing the evaluation and summary of compliance data, audit information, and potential risks and remedies; identifying and reporting key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations) to senior management; and developing complex presentations to convey key findings to executive leadership and external business stakeholders.
Directs compliance investigations across multiple business functions by overseeing the collection and analysis of quantitative and qualitative data; conducting interviews on escalated issues as appropriate; reviewing and evaluating research on key business issues; and evaluating and recommending corrective action plans for substantiated allegations.
Directs programs or compliance components of larger cross-functional programs by identifying and managing stakeholder contacts; assembling teams based on program needs and team member strengths; developing, analyzing, and managing program plans; negotiating and managing program schedules and resource forecasts; and managing program financials and deliverables.
Directs activities associated with continued regulatory compliance for multiple business functions by monitoring, interpreting, and designing strategy around regulatory changes; determining the impact of changes to the business; providing direction on implementation of changes throughout the business; and providing regulatory input before and during inspections to minimize the risks of future non-compliance.
Directs and oversees the implementation of compliance efforts by approving compliance requirements; ensuring the assessment of current state compliance to identify gaps and corrective actions; overseeing the analysis and development of complex compliance standards, policies and procedures, and training; and ensuring the monitoring of ongoing compliance adherence.

Knowledge, Skills and Abilities: (Core)

Ambiguity/Uncertainty Management
Attention to Detail
Business Knowledge
Communication
Constructive Feedback
Critical Thinking
Cross-Group Collaboration
Decision Making
Dependability
Diversity, Equity, and Inclusion Support
Drives Results
Facilitation Skills
Health Care Industry
Influencing Others
Integrity
Leadership
Learning Agility
Organizational Savvy
Problem Solving
Short- and Long-term Learning & Recall
Strategic Thinking
Team Building
Teamwork
Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

Analytical Skills
Compliance Management
Cross Department Coordination
Getting Work Done Through Others
Negotiation
Project Management
Technical Communication
Written Communication

Minimum Qualifications:

Minimum four (4) years experience in a leadership role with or without direct reports.
Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum ten (10) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

Preferred Qualifications:

Five (5) years experience working in a clinical setting (e.g., hospital, medical center).
Five (5) years experience in health plan compliance.

Primary Location: Georgia,Atlanta,Regional Office - 9 Piedmont
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 09:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: NUE-GA-01|NUE|Non Union Employee
Job Level: Director/Senior Director
Department: Regional Office - 9 Piedmont - Assoc Rgnl Med Facility - 2808
Pay Range: $163500 - $211530 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: Yes, 15 % of the Time
On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

About the Company

Kaiser Permanente

At Kaiser Permanente, we are relentless in our pursuit of excellence. Driven by our mission to provide the highest quality preventive medicine, we are committed to eliminating health care disparities, and to making lives better through innovation, technology, and research. Our desire to deliver the best possible care inspires us to promote wellness among our members, communities, and each other. It also fuels our belief that everyone — regardless of circumstance — deserves access to affordable care, which further drives our motivation to expand our reach. Founded nearly 80 years ago, our unique business model sets us apart — positioning us to drive improvements across the industry and around the world.

COMPANY SIZE

10,000 employees or more

INDUSTRY

Healthcare Services

FOUNDED

1945

WEBSITE

http://www.kp.org/careers

Utilization Management Director, Compliance

Kaiser Permanente

Atlanta, GA

About the Company

Kaiser Permanente

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