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Health Care Specialist

Company: Innovative Integrated Health Inc
Location: Fresno
Posted on: January 7, 2021

Job Description:

Description:

Innovative Integrated Health- Fresno PACE for Seniors
WHO WE ARE:
Are you interested in working for an organization whose mission it is to enable frail, underserved, and multicultural senior communities to live independently at home and in their communities, for as long as possible?
Fresno Program of All-Inclusive Care for the Elderly (PACE) is dedicated to providing its participants with comprehensive health and social supports that are proven to effectively manage chronic conditions and to reduce the risk for premature institutionalization. PACE staff are leaders in the "aging in place" industry and we have had the honor of serving Fresno County seniors and their families/caregivers for the past five years.
Responsibilities:
Under the supervision of the Director of Regulatory Affairs, the Health Care Specialist is responsible for the design and execution of monitoring compliance work plans for PACE sites and designated Part D operational processes. This Health Care Specialist will ensure compliance with all regulatory requirements and standards relative to all PACE sites and the Medicare Part D and related state Medicaid programs. This individual is responsible for conducting FDR oversight (including PBM and contracted Pharmacies) and Part D program monitoring in such a way that ensures (i) that all Medicare Part D regulatory requirements and standards are understood, (ii) business processes required to address those regulations and standards are implemented i.e. TROOP-IN/TROOP-OUT policies and procedures and (iii) any compliance risks are communicated to the Director of Regulatory Affairs.
The Health Care Specialist will research compliance issues and recommend changes that assure compliance with contract requirements as well as coordinate the creation and review of corrective action plans necessary to address compliance issues. The Health Care Specialist is responsible for (i) supporting the implementation of CMS guidance relating to assigned FDRs and ongoing auditing of said guidance; (ii) perform annual FDR audits, applicable pre-delegation audits, and any other applicable audits; (iii) designing and executing ongoing FDR monitoring plans; and (iv) working with Part D business owners to ensure timely and appropriate closure of any issues that surfaced from monitoring/auditing. This position will support both the FDR monitoring and Part D program audit as assigned.
The successful candidate must be well versed in the CMS PACE Manual and Medicare Part D Prescription Drug Benefit Manual. This candidate must exhibit superior analytical, communication and collaborative skills, as well as the ability to excel in a dynamic, fast-paced environment. This compliance team member must be adept at working with a variety of internal and external stakeholders. This candidate will promote an enterprise-wide culture of compliance and provide first-rate support within the Compliance Department and across business units.
Competitive Benefits and Salary:

  • Desirable work schedule
  • Health Insurance Coverage (Medical, Dental and Vision)
  • 401K
  • Life Insurance
  • Paid time off (including holidays, vacation and sick time)
  • Competitive Salaries and bonuses
  • Recruitment Referral Bonus Program
  • Free covered parking located downtown
  • Professional development opportunities
  • Employee Recognition events and activities
  • Please contact Human Resources for salary information
    Location: Historic downtown Fresno, California within walking distance to shops, restaurants and the Fresno Grizzlies Stadium.
    Business Hours: Monday - Friday / 8:00 a.m. to 5:00 p.m.
    . Requirements:
    • Bachelor's Degree required
    • Master's degree within healthcare field is preferred.
    • Minimum of one (1) year of documented experience in working with a frail or elderly population required.
    • Minimum of three (3) to five (5) years' experience in Medicare Part D regulatory management, regulatory audits, or equivalent strongly preferred.
    • Prefer experience in a community-based setting or geriatric program.
    • Current CPR/BLS certification is preferred.
    • Is medically cleared for communicable diseases and has all immunizations up-to-date before engaging in direct participant contact.

Keywords: Innovative Integrated Health Inc, Fresno , Health Care Specialist, Healthcare , Fresno, California

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