Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

Administers and provides oversight of the Sutter Health (SH) ethics and compliance program at the market/network/system service line level. Functions as the team lead for a market/network/system service line and is an administrator for the SH compliance program. Provides oversight and guidance and data collection for board activities within their market/network/system service line. Serves as a member of a single market/network/system service line leadership team and leads the ethics and compliance program in accordance with the expectations of the Federal Sentencing Guidelines, HHS Office of the Inspector General and the HHS Department of Justice.

Oversees the development and implementation of processes, tools and templates, compliance training and education, and other resources to ensure a consistent and effective compliance program throughout the. Authors advisories and alerts, and works with program implementation teams to address risk. Has oversight of the investigation and remediation of high-risk compliance issues within their market/network/system service line or team of ethics and compliance officer. Coordinates with ethics & compliance services leaders and team members to ensure system-wide coordination for risk mitigation. Completes required reporting and interactions with the local, state, and federal governments. Completes due diligence on medium-risk level mergers and acquisitions.

Participates and provides direction within the assigned market/network/system service line and leads market/network/system service line task forces designed to reduce compliance related risk. Serves as expert on significant compliance issues, program development/effectiveness, and fosters compliant work environment to achieve legal and regulatory requirements.

Responsible for market/network/system service line ethics & compliance services staff development including succession planning. Represents the SH ethics & compliance program.

(Intended for use by SHSO only)

Job Description :

EDUCATION:

Equivalent experience will be accepted in lieu of the required degree or diploma

Master's: Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH) or related field

CERTIFICATION & LICENSURE:

CHC-Certified in Healthcare Compliance

TYPICAL EXPERIENCE:

12 Years of recent relevant experience.

SKILLS AND KNOWLEDGE:

Comprehensive expertise in managing an effective ethics and compliance program, including: infrastructure development; policy management; training; monitoring/auditing; conducting and documenting investigations; addressing and resolving violations, errors, and deficiencies; tracking corrective actions, performing risk assessments, and designing strategies to prevent future compliance problems.

Expert level knowledge of healthcare compliance standards, compliance program development and assessment, relevant healthcare operational issues, business ethics and compliance risks and the knowledge to effectively manage those risks in a dynamic healthcare environment.

Expert level of knowledge regarding healthcare operations, revenue cycle, billing, coding and federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal).

Well versed in current regulations that govern healthcare operations, including the California Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act and Health Insurance Portability and Accountability Act (HIPAA) regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Insurance Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws, and licensure requirements, and quality standards.

Expert level knowledge of federal and state anti-kickback and physician self-referral laws (e.g., Stark and PORA), and provider and practitioner licensure and scope of practice requirements, privacy, and consent laws.

Expertise in current and emerging business ethics and compliance topics, project management methodologies and tools, resource management and change management techniques.

Detailed knowledge of other disciplines outside own area of expertise, including strategy, clinical disciplines, human resources, finance, clinical and financial auditing, and information technology.

Superior business acumen and exceptional leadership skills to provide innovative solutions to complex problems and leveraging appropriate internal/external resources to meet corporate objectives.

Exceptional managerial and organization skills required to create plans and strategies with the proven ability to articulate the value of these plans/strategies, assemble consensus across all levels of the organization, and lead others through change.

Advanced management skills, including the ability to facilitate and manage multiple complex projects simultaneously while efficiently and effectively achieving objectives.

Expertise with attention to detail, superior analytical and strategic planning skills with the ability to identify potential issues/risks/trend, analyze data, provide insights to staff and affiliates, and recommend actions to resolve or minimize the impact.

Excellent written/verbal interpersonal communication skills with the ability to articulate a vision, translate complex business ideas into lay terms, and to engage with diverse audiences, including peers, senior leadership, internal/external legal parties, insurance brokers, and government agencies.

Proficient computer and related software application, including Microsoft Office suite (Word, Excel, PowerPoint), including a working knowledge of data management to interpret information and track results, and internet-based legal and regulatory research.

Ability to

• translate vision into a tangible plan and develop clear ethics and compliance goals/objectives that support the strategic plan.

• influence others outside of direct reporting relationships or lines of authority, from senior management and the Board to those providing direct patient care and services.

• analyze problems and issues from a variety of perspectives to understand the legal, clinical, and human resource impact of decisions.

• develop cross-functional teams, foster consensus, resolve conflicts, and manage risk, in addition to being an effective decision maker and expert delegator.

• foster an environment of collaboration at all levels of the organization, including engaging influencing individuals or groups, building consensus, and then enlisting cooperation without direct control/ authority.

• establish, build, and maintain working relationships with staff, peers, senior leadership, physicians, existing and potential vendors, governmental agencies, and industry organizations.

Job Shift :

Days

Schedule :

Full Time

Shift Hours:

8

Days of the Week:

Friday, Monday, Thursday, Tuesday, Wednesday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $88.63 to $141.82 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.