Health Alliance, a 250,000 member physician sponsored health plan and wholly owned subsidiary of Carle Health System, is seeking an executive leader to oversee and support Compliance and Enterprise Risk Management as they relate to all health plan lines of business.
Carle is a not-for-profit, locally owned and operated three hospital regional healthcare system that includes Carle Foundation Hospital, a 413-bed Level 1 Trauma Center, Carle Physician Group boasting 450+ physicians and over 650 total providers, and Health Alliance, the largest health plan in downstate Illinois with hundreds of network hospitals and provider groups in Illinois, Indiana, Iowa and Washington.
The Vice President, Chief Compliance and Risk Officer will have responsibility for the overall success of the Compliance and Enterprise Risk Management departments including the development of new protocols and processes, direct oversight of all compliance and risk related programs as well as the internal auditing and monitoring of the organization’s activities.
Responsible for health plan activities to ensure compliance with State and Federal, Medicare, QHP/Marketplace and Medicaid regulatory guidance, rules and requirements
Serve as liaison and assist with strategic planning for state and federal relationships
Creates effective, efficient company-wide regulatory compliance and legal review programs to assurance and improved documentation
Responsible for decision-making, review of reports and approval of all Enterprise Risk Management procedures and measurement methodologies
Provides leadership to Enterprise Information Security initiativesQ
Oversees fraud, waste and abuse as well as coding discrepancy review
The Vice President, Chief Compliance and Risk Officer will report directly to the Chief Executive Officer with a close matrix relationship to the Senior Vice President of Corporate Affairs & General Counsel.
The Vice President, Chief Compliance and Risk Officer will be a dynamic leader with strong business acumen, and impeccable communication and presentation skills. This individual must appreciate the complexity of a health plan environment, specifically within an integrated health delivery system, which leverages Medicare Advantage programs as its value proposition. This person must have prior experience with multi-state start-up plans, network partnership, and plan expansion. This individual will also possess the ability to articulate and deliver a message system-wide as well as to external partners.
Experience and Qualifications
Minimum five (5) years of experience working with health plan compliance, enterprise risk management, governmental relations, regulatory/legislative research and regulatory contact
Master’s degree in related field
Knowledge of state & federal insurance laws & regulations (ERISA, HIPAA & Medicare)
Knowledge of FWA and coding compliance
Knowledge of pharmacy compliance requirements
Headquartered in Champaign-Urbana, Illinois, Carle services approximately 1.5 million residents in 22 counties in Central/Eastern Illinois and Western Indiana. Carle has one of the largest outpatient treatment centers in Illinois and encompasses fourteen regional branch clinics. Home to the University of Illinois, Champaign- Urbana is a diverse community of 195,000, which offers cultural, sporting and entertainment options typically associated with much larger cities. The community is centrally located two hours from Chicago and Indianapolis and three hours from St. Louis.
Interested and qualified candidates are encouraged to forward a resume to:
Stratum, incorporated in 1996, is a collaborative alliance of physician-owned and health system-employed physician groups that have come together to leverage cost savings through aggregation and to provide a platform for networking and shared learning. Shareholders are located in Illinois, Iowa, Indiana, Kansas, Michigan, Missouri, and Wisconsin. Stratum has selectively added Shareholders and “Clients” and now consists of sixteen owners in addition to approximately fifty clients located throughout the country.