PACE Compliance Manager [United States]

 Position Summary:
The PACE Compliance Manager reports to the PACE Director of Quality and Compliance and is responsible for ensuring San Diego PACE remains compliant with the regulatory, licensing, and contractual requirements set forth by the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and other regulatory agencies. The Compliance Manager’s primary focus is the development, implementation, and day-to-day operations of an effective compliance program. The Compliance Manager performs regulatory compliance activities and implements monitoring initiatives related to the Program of All-Inclusive Care for the Elderly (PACE).

Essential Functions of the Job:

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• Develops and implements training programs regarding the Organization’s Compliance Program.
• Develops and maintains compliance reporting mechanisms that are accessible and confidential and that allow employees and contractors to report suspected fraud, waste, and abuse and other non-compliance on an anonymous basis and without fear of retaliation.
• Ensures OIG and SAM exclusion lists, CMS’s preclusion list, state nurse aide registry, Medicare opt-out list, and state-required exclusion lists have been checked monthly with respect to all employees, governing body members, and contractors, as applicable, and coordinating results with Human Resources, Security, Legal or other departments as appropriate.
• Regularly checks the CMS website for relevant new or revised guidance materials, and making recommendations to the Board for incorporating new or revised guidance into the Compliance Program, as appropriate.
• Monitors regulatory communications from CMS, DHCS, and other regulatory agencies. Participates in conference calls and training webinars from regulators and/or associations. Reviews, analyzes, and interprets changes and/or updates to regulatory requirements to assess its impact to PACE operations and reporting. Develops, communicates and disseminates guidance to internal departments, provides consultation, and tracks implementation and appropriate training.
• Interacts with various departments to develop, review, and revise internal policies and procedures and to verify compliance with regulatory, licensing, and contractual requirements. Provides support for the San Ysidro Health’s Policies and Procedures Committee and Medical Forms Committee. Manages the coordination, approval, and dissemination of new or revised policies and procedures.
• Assists with the coordination, tracking, and filing of routine and ad-hoc reports and filings. Provides guidance to internal departments regarding reporting requirements.
• In coordination with San Diego PACE Leadership, facilitates site visits from federal and state regulators. Develops cross-departmental work plans for external regulatory audits. Manages the collection, review, and quality check of deliverables, including audit data universes. Coordinates with internal departments in developing corrective action plans in response to audit deficiencies and monitors status.
• Manages the monitoring of internal and external processes and functions to facilitate compliance with regulatory requirements. Presents results and recommendations for improvement to management.
• Investigates and analyzes non-compliance issues as they arise. In consultation with San Diego PACE Leadership, provides appropriate and timely guidance, outreach, and communication to internal departments.
• Ensures annual risk assessments are completed and priority risks are identified in an annual monitoring and auditing work plan that is approved by the Compliance Committee including identifying proper resources and strategies to address risks.
• Collaborates with San Diego PACE Leadership to develop a periodic report for the Board of Directors, the CEO, other senior management, and the Compliance Committee regarding the activities and status of the Organization’s Compliance Program.
• Provides leadership and direction to the Compliance Specialists including recruitment, training, performance management, and evaluation.

Additional Duties and Responsibilities

• Performs other regulatory compliance activities and monitoring initiatives as assigned by San Diego PACE Leadership.
• All other duties as assigned.

Job Requirements

Education Required:

• Bachelor’s degree

Experience Required:

• Minimum of three (3) years’ previous experience in performing the duties in a Corporate Compliance, Auditing, Quality Assurance; and/or Risk Management.
• Training and/or experience working with PACE, MA, MA-PD or PDP programs.
• Experience in training and PowerPoint presentations.

Verbal and Written Skills Required to Perform the Job:

• Excellent interpersonal skills.
• Excellent verbal and written communication skills.

Technical Knowledge and Skills Required to Perform the Job:

• Strong knowledge of management principles and practice.
• Good organizational and analytical skills.
• Ability to prioritize; ability to coordinate a high level of activity under a variety of conditions and constraints.
• Knowledge in Medicare Parts C & D Fraud, Waste, and Abuse.
• Knowledge in Nondiscrimination in Health Programs and Activities sec. 1557

Equipment Used:

• General office Equipment to include Personal Computer, Phones, Fax, etc.

Working Conditions and Physical Requirements:

• This is a regular, full-time hybrid position, with 85-90% of work expected to be completed remotely. Flexibility and willingness to work long and irregular hours and days, including evenings and weekends as needed.
• Sitting for extended periods of time.
• Sufficient dexterity to effectively operate a computer keyboard and other related peripherals.

Universal Requirements:
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

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