Compliance Officer, County Care

at Cook County Government in Chicago, Illinois, United States

Job Description

Job Summary
The Compliance Officer reflects the mission and vision of Cook County Health (CCH), adheres to the organization's Code of Conduct and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Compliance Officer is responsible for the ongoing development, implementation, maintenance, and evolution of the CCH compliance program and all related compliance activities. This includes, but is not limited to, the development and subsequent assessment of comprehensive policies and procedures, protocols, compliance training, and internal investigations.

This position is exempt from Career Service under the CCH Personnel Rules.

General Administrative Responsibilities
Collective Bargaining
Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Discipline
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies,

.procedures and provision of applicable collective bargaining agreements

Supervision
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Management
Contribute to the management of CCH staff and CCH' systemic development and success
Discuss and develop CCH system policy and procedure

General Administrative Responsibilities continued
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Typical Duties
Governance of the Health Plan's Fraud, Waste, Abuse (FWA) and Financial Misconduct Program (Program Integrity Program); Special Investigations Unit; to ensure that FWA and Financial Misconduct is actively administered , as delegated by the Chief Corporate Compliance & Privacy Officer
Monitors operational management of the Health Plans' complaint, grievance, appeals and the fair hearing process received from members and care providers for program compliance in addition to trends and patterns through reports and data analysis
Collaborates with the Chief Corporate Compliance & Privacy Officer to ensure that FWA is reported in accordance with federal, state and local requirements, as well as the guidelines in the Medicaid Managed Care regulations at 42 CFR §438.608 and the CCH Managed Care Community Network (MCCN) Agreement with Healthcare Family Services (HFS)
Implements and coordinates methods and programs that encourage workforce, employees and independent contractors to report issues related to noncompliance and potential  FWA

without fear of retaliation
Reviews health plan agreements, contracts, addenda, and other relevant documents, as needed.
Aligns with operational management of the Health Plans' sanction/exclusion check to ensure that providers, management, workforce and independent contractors (where necessary) are screened against applicable Federal and state sanction and exclusion lists.
Coordinates potential fraud investigations/referrals with the Special Investigations Unit (SIU), where applicable.
Collaborates with other health plans, HFS, Medicaid Fraud Control Units (MCFUs}, commercial payers, and other organizations, where appropriate, when a potential FWA issue is discovered that involves multiple parties.
Serves in a leadership capacity to develop the system-wide compliance program in conjunction with the Chief Corporate Compliance & Privacy Officer
Collaborates with operational leadership to facilitate operational ownership of compliance
Synchronizes system-wide compliance program materials and messaging to present a uniform approach  .
Oversees, directs, delivers, tracks, or ensures delivery of compliance training, both global and specialty, for employees, physicians, volunteers, students, vendors, and consultants
Develops, assesses, evaluates, implements, maintains, and updates compliance policies and procedures to ensure adherence with the requirements
Establishes a structured process for regulatory review, monitoring, and dissemination of information. Modifies policies, procedures, and projects to reflect changes in laws and regulations
Develops and coordinates compliance projects with CCH... For full info follow application link.

COOK COUNTY HEALTH AND HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER