Clinical Compliance Officer

at  Blue Cross Blue Shield of Arizona

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

REQUIRED QUALIFICATIONS

Required Work Experience

• 7 years of management experience
• 7 years of experience in healthcare compliance
• 5 years of experience in a clinical setting (outpatient treatment centers, ambulatory surgery centers, etc.)

Required Education

• Bachelor’s or Master’s Degree in psychology, social work, nursing or other related medical field

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 10 years of experience in healthcare compliance

Preferred Education

• Master’s degree in business, healthcare policy, judicial studies, ethics or related field

Preferred Licenses

• N/A

Preferred Certifications

• Compliance Certification from recognized accrediting body

PURPOSE OF THE JOB

Serves as the Clinical Compliance Officer for the Organization (parent company, affiliates, and subsidiaries). Responsible for ensuring overall compliance of all clinical compliance activities and programs for the Organization, including the Organization’s outpatient treatment and other medical centers.

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Develop and/or maintains the comprehensive Clinical Compliance Program and Work Plan for the Organization, including responding to all clinical compliance questions or concerns.
• Create, implement, and maintain an effective Clinical Compliance Program for the Organization’s outpatient treatment and other medical centers.
• Manage large clinical compliance projects, including Mental Health Parity and mandate implementations impacting clinical workflows to completion.
• Implement a process for consistent standards for self-disclosures of non-compliance to appropriate governing agencies, including Arizona Department of Health Services.
• Promptly investigate and respond to inquiries and complaints and prepares reports for the Chief Compliance and Privacy Officer on a regular basis concerning the status of the Clinical Compliance Program and related investigations.
• Review at least annually and update as needed the Clinical Compliance Business Continuity Plan.
• Prepare for and respond to Arizona Department of Health Services and other external audits.
• Perform site visits of clinics to monitor compliance.
• Develop and distributes clinical compliance training programs for the Organization’s employees, and applicable suppliers.
• Communicate the importance of the Compliance & Ethics Program to executive leadership and governing bodies throughout the Organization, including but not limited to Boards of Directors, Boards of Managers, and Audit & Compliance Committees of various subsidiaries and affiliates either as a reporting Compliance Officer or committee/board member.
• Manage, either directly or through dotted line reporting, any aspects of clinical compliance that may be decentralized within the Organization.
• Work diligently to foster a culture and climate of sensitivity to ethical and compliant behavior within the Organization, including a culture of compliance.
• Develop productive working relationships with Legal, Human Resources, Clinical Excellence and others as appropriate to effectively communicate clinical compliance and ethics standards to all departments and entities at the Organization and serve as a compliance resource.
• Maintain effective working relationships to ensure teamwork in achieving corporate goals.
• Participate in strategic planning activities and contributes to departmental and cross-functional teams to achieve AZ Blue goals and ensure future success.
• Coordinate activities between multiple divisions to achieve desired results.
• Participate in local and national compliance education and networking programs for healthcare compliance professionals.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• This position will require at least weekly on-site engagement.
• Perform all other duties as assigned.