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Job Details

Director ACO Regulatory Compliance

Category: Professional and Management
Malden, MA

Department: Population Health Performance
Employment Type: Full Time
Job Type: Non-Union
Work Shift: Days
Work Days: M-F
Hours/Week: 40
Date Posted: 06/16/2017
Requisition Number: hrq-76456

Job Details

  • Job Purpose

    • Responsible for achieving successful ACO regulatory and certification requirements by providing oversight and project management of all ACO Regulatory & Certification requirements. • Serves as the point person for these activities with key internal and external stakeholders.

    Job Duties

    ·         Coordinates all ACO Regulatory & Certification requirements with key internal and external stakeholders including but not limited CHA Legal and Government Relations departments

    ·         Collaborates with other departments to address and resolve operational issues related to ACO Regulatory and Certification requirements

    ·         Researches and tracks applicable state and federal laws and certification requirements as they relate to the Cambridge Health Alliance Accountable Care Organization

    ·         Analyzes the impact of regulatory requirements and creates implementation, communication plans and project manages all the related requirements

    ·         Ensures preparedness, facilitates and coordinates across organizational functional areas for all required regulatory filings and certifications including but not limited to:

    o   ACO related Delivery System Transformation Initiatives

    o   Registered Provider Organization (RPO)

    o   Risk Based Provider Organization (RBPO)

    o   Health Policy Commission (HPC) ACO Certification

    o   Accountable Care Partnership Plan (ACPP) Readiness Reviews and Surveys

    o   NCQA ACO Certifications

    o   Health Policy Commission and NCQA Prime Certification

    o   HEDIS Performance Measures

    ·         Coordinates and ensures successful submission, implementation and organizational communications for all applicable Request for Responses (RFR), and Request for Proposals (RFP), regulatory and certification applications and surveys

    ·         Organizes preparedness for regulatory report as it related to the impact of Social Determinants of Health requirements on ACO business

    ·         Communicates to external agencies as required

    ·         Participates in external stakeholder processes as required

    ·         Participates in ACO Committees as requested

    ·         Supports ACO and Organizational Projects as requested

    ·       Qualifications

    • Education/Training: Bachelor's degree in Business Administration, Health Administration or Public Health; Master's Degree Preferred • Certifications: Project management certification preferred. • Work Experience: o Minimum of ten (10) years' experience with a managed care organization, payer, health systems or a health care related organization (HMO; Medicaid; Medicare) • Demonstrated knowledge and experience in one or many of the following areas preferred: ACO management, NCQA standards and processes, Division of Insurance and Health Policy Commission requirements, service delivery coordination, payer contracting compliance, financial compliance or and regulatory compliance • Experience with National Committee for Quality Assurance, Department of Insurance, Health Policy Commission, Medicaid and Medicare requirements for ACOs • Experience with external regulatory bodies • Demonstrated experience with managing and cultivating strong business relationships • Ability to lead workgroups and manage process in a cross-functional environment • Demonstrated success project managing multiple and complex projects and project requirements simultaneously •Intermediate to Advanced skills in Microsoft Office (Word, Excel, PowerPoint and Project Management tools and software) • Ability to manage data and processes in multiple platforms • Demonstrated organization, facilitation, presentation and training skills including strong attention to detail • Excellent communication skills (written and verbal) • Strong analytical, critical reasoning, prioritization and organizational skills.





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