Why This Role is Important to Us

The Senior Director, Third Party Compliance Oversight reports directly to the SVP, Corporate Compliance & Ethics and Risk Operations, and leads the Third-Party Compliance Oversight department for Commonwealth Care Alliance (CCA). This position effectively leads our Third-Party Compliance Oversight programs which includes monitoring and evaluating the performance of delegated third parties according to CMS, federal, and state requirements in a manner that continually supports the business and operational areas.

What You'll Be Doing

Strategically leads the Third-Party Compliance Oversight Department staff that perform compliance oversight and monitoring of delegated third parties including Medicare FDR; Duals/SNP; and Medicaid/LTSS programs. Coordinates and reviews work completed by Third-Party Compliance staff including risk assessments, compliance program reviews, pre-delegation screenings and various items for accuracy and completeness. Manages and monitors third parties against CMS, contractual, federal, and state requirements. Ensures strategic and operational partnership and collaboration with the business and operational areas, as well as with GRC teams to leverage cross-departmental synergies and efficiencies. Maintains strong communication and working relationships with internal and external business partners. Develops clear, effective, and timely reports and updates for senior management and/or the Board regarding Third-party Oversight Compliance Program effectiveness, initiatives, and issues, including all relevant metrics, dashboards and information. Reviews, researches, interprets and summarizes federal and state regulations and ensures timely training of key personnel impacted by new or changed regulations. Facilitates and participates in team and committee meetings, providing ideas and suggestions to ensure compliance standards are met. Assesses, investigate, and resolve issues to ensure customer satisfaction. Maintains a positive work environment and supports the experience, skill, knowledge, and growth opportunities of all employees. Coordinates and performs on-going monitoring of third-party activities to ensure compliance. Works closely with the Governance, Risk & Compliance (GRC) teams (Medicare, Medicaid, Privacy, Fraud, Waste & Abuse) for dissemination of new or revised requirements applicable to the delegated third-party. Oversees, develops, and maintains reporting and metrics for delegated third-party activities. Ensures timely receipt of accurate and complete reporting for all regulatory and contractually required reports for delegated third parties. Oversees the process for completing Third-Party Pre-Qualification/Delegation Assessments. Oversees the process for Third-Party Annual Attestations. Oversees and conducts risk assessments for each third-party. Develops and maintains oversight document evidence related to compliance oversight in preparation for state, federal and regulatory audits. Monitors and audits delegated third parties to ensure compliance with state and federal requirements. Executes compliance monitoring plans to monitor delegated third parties to meet regulatory oversight and compliance requirements. Oversees, develops, assesses, and adapts clear and effective remediation and corrective action initiatives, protocols, and controls to ensure proper and timely compliance. Stays abreast of changing industry requirements and regulations, including all relevant laws, rules, contractual agreements, industry standards, company practices and initiatives. Provides clear and effective reports to the relevant business, functional and operational areas, as well as other internal/external stakeholders, regarding new laws, regulations, contractual requirements, industry standards and best practices. Performs other duties as assigned.