Director Regulatory Compliance Population Health

Overview:

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups hospitals health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical dental and vision plans for the employee and their dependents Health Spending Account (HSA) Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

***This position is remote.

Position Summary:

The Director of Regulatory Compliance Population Health will serve as the strategic leader responsible for ensuring the integrity and effectiveness of the Population Health Services Organization’s (PHSO) compliance programs, policies, and strategy. This role is pivotal in integrating a common approach to risk-bearing contracts, aligning Value-Based Care (VBC) incentives with compliance guardrails, and managing the long-term compliance strategy to adapt to the evolving regulatory landscape.
The Director will work closely with various internal teams, including Customer Success, Compliance, and Legal, to develop and implement policies and procedures that meet regulatory requirements (CMS, NCQA, etc.), mitigate risks, and promote a culture of compliance across the PHSO and regional Value Hubs. The Director has a deep understanding of healthcare regulations, seeking out additional assistance / expertise, when necessary, exceptional project management skills, and the ability to lead cross-functional initiatives in a matrixed environment that drive organizational excellence in quality and risk management.
The position also has management responsibility for all PHSO Risk staff and departments as assigned. The Director is responsible for the operational activities within the departments assigned including but not limited to interviewing, hiring, corrective actions and termination of employees within the team.

Responsibilities may include:
1. Facilitate the application of the national compliance strategy with consistent practices across the organization; modifying work-flow, processes and/or internal auditing functions as necessary to meet local needs and continuously improve performance.
2. Develop detailed project plans, including timelines, milestones, and resource allocation, to support compliance initiatives
3. Ensure compliance with all relevant regulations, including but not limited to HIPAA, HITECH, CMS, NCQA, and state-specific healthcare regulations.
4. Coordinate with internal teams to gather necessary data and documentation for MSSP and MA reporting, and subsequently, prepare and submit accurate and timely regulatory filings and reports to CMS for MSSP and MA programs
5. Design and implement CAHPS surveys to gather patient feedback and analyze results to improve patient care; develop strategies to enhance patient satisfaction based on CAHPS findings.
6. Collect, analyze, and report HEDIS data to assess healthcare service performance against industry standards and identify areas for improvement; develop and implement processes to ensure accurate and timely HEDIS data collection and submission
7. Coordinate with Customer Success PHSO leadership team to monitor and evaluate the performance of risk-bearing contracts to identify areas for improvement, target performance incentives, and ensure compliance with regulatory requirements.
8. Coordinate with Performance & Insights PHSO leadership team to ensure data compliance with payors and track reports.
9. Keeps abreast of changing regulatory requirements/regulations, professional standards and competitive industry practices impacting the PHSO, as well as organizational initiatives/changes with potential to impact current operations and the national population health compliance strategy; monitor impact on existing activities and identifies/implements effective response/solution while maintaining acceptable service levels and work quality.
10. Conduct regular compliance audits and risk assessments to ensure adherence to regulatory requirements and organizational policies.
11. Respond to requested audits and reports from regulatory bodies and payors (PSV, CAP, AMP Reports, etc.).
12. Produce reports on key performance indices and other significant benchmarking metrics in collaboration with PHSO Leadership and Value Hub governance, as required.
13. Collaborate with other PHSO departments and Value Hubs to address and resolve problems, share information and enhance overall effectiveness/productivity.

14. Support in the preparation and administration of the annual operating budget; responsible for effective cost control by monitoring and adjusting expenses as needed to stay within budget; approve expenditures within defined scope of responsibility; identifies negative variances and develops action plans to document.

Minimum Qualifications:

- Bachelor’s Degree in related discipline
- 5 years of leadership experience with a minimum of 3 years at the manager level

- Comprehensive understanding of the healthcare industry, regulatory bodies, and risk/quality management

- Demonstrated experience in quality compliance in a MSO, health plan or health care setting
- Extensive knowledge of value-based care
- Demonstrated ability to build and lead a high performing service organization
- Demonstrated ability to oversee and positively impact operations in a large healthcare organization through a matrix relationship
- Strong working knowledge of software platforms
- Budgeting experience

Preferred Qualifications:

- Master’s Degree strongly preferred
- Certification in healthcare compliance (e.g., CHC, CHPC) may be advantageous

- Experience overseeing a national team strongly preferred

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