Job Description

　　Job Summary

　　Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations. Serve as the Compliance Officer for the New Mexico Health Plan. Reports to Health Plan President and Health Plan Board of Directors.

　　Knowledge/Skills/Abilities

　　• Responsible for oversight and management of Health Plan Compliance Directors for all compliance activities and serves as a resource on compliance issues. Provides leadership and expertise to help facilitate compliance with applicable statutes and policies.

　　• Provides leadership to Health Plan Compliance Directors on training and education of compliance requirements. Provides specialized compliance education and training when necessary.

　　• Enforces, as a representative of management, the Compliance Plan, Code of Conduct and Anti-Fraud Plan.

　　• Establishes, at the direction of the AVP of Compliance or the AVP of the Corporate SIU an active relationship with third parties who have specific experience in conducting fraud and abuse investigations.

　　• Prepares written reports to inform the AVP of Compliance, no less than quarterly, the status of activities pertaining to overall Health Plan compliance..

　　Job Qualifications

　　Required Education

　　Graduate Degree or equivalent combination of education and experience

　　Required Experience

　　7-9 years Health Plan Operations or Compliance experience.

　　Preferred Education

　　Master's degree

　　Preferred Experience

　　10+ years Health Plan Operations or Compliance experience.

　　Experience with Governance Risk Compliance (GRC) systems.

　　Compliance 360

　　Excel - VLOOKUPS, Pivot Tables.

　　Power BI

　　To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

　　Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

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　　Pay Range: $105,568.7 - $153,732.18 / ANNUAL

　　*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.