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Compliance Manager, MA Advantage

Overview

The Visiting Nurse Service of New York (VNSNY) is the nation's largest not-for-profit home- and community-based health care organization, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For 125 years, VNSNY has been committed to meeting the health care needs of New Yorkers with compassionate, high-quality home health care. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, members, and clients from before birth to the end of life.

Each day, more than 13,000 VNSNY employees- including nurses, rehabilitation therapists, social workers, other allied professionals, and paraprofessionals- deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to more than 48,000 patients and members, helping them to live the best lives possible in their homes and communities.

Responsibilities

Currently have two open Compliance Manager positions, one supporting Corporate & Provider compliance and the other supporting MA Advantage/Integrated Health Plans.

Manages the activities of the Compliance Program for VNSNY CHOICE and community benefit programs to ensure compliance with all applicable local, state and federal laws and regulations. This includes the ongoing implementation of the Code of Conduct and other Compliance Program policies and procedures as well as additional duties to support the achievement of the objectives of an effective compliance program. Works under general supervision.

  • Manages day to day functions of the CHOICE Compliance Programs.
  • Audits and monitors activities in accordance with the Compliance Workplan; prepares summary reports for leadership.
  • Conducts investigations of allegations or reports of fraud, waste and abuse and/or privacy violations under the direction of compliance and legal counsel leadership, as appropriate.
  • Provides education and training to enterprise staff on compliance related issues.
  • Collaborates with leadership in developing, reviewing, and revising compliance policies, procedures and related activities for the enterprise. Ensures that enterprise staff are aware of and in compliance with policies and procedures.
  • Collaborates with operations to implement corrective actions and implement controls related to identified compliance concerns; evaluates the efficacy of the controls.
  • Collaborates with Human Resources and enterprise leadership to ensure consistency of disciplinary actions related to matters of non-compliance, especially those related to fraud, waste and abuse and privacy violations.
  • Assists with responses to external requests including, but not limited to, government audits and record requests from oversight agencies.
  • Keeps up to date regarding compliance and privacy laws, regulations and trends for all VNSNY entities and programs. Serves as a resource to staff with regard to compliance related matters and questions.

Education: Associate’s, Bachelor’s or Master’s degree. Compliance certification preferred.

Experience: Minimum of five years of progressive experience in a health carecompliance environment required. Demonstrated knowledge of federal and state health care compliance laws, regulations and requirements required; knowledge and experience with compliance requirements applicable to VNSNY provider and community benefit programs preferred. Strong written and verbal communication, as well as interpersonal and management skills, required.

CA2019