Regulatory Operations Jobs in Remote, OR (NOW HIRING)

SUMMARY

The Chief Operating Officer – Health provides executive leadership, strategic direction, and operational oversight for the CTCLUSI Health Division, including medical, dental, behavioral health, pharmacy, prevention, community and public health, and other specialized health services. This position is responsible for ensuring the effective, compliant, and financially sustainable delivery of health services through strategic planning, quality improvement, regulatory compliance, financial and revenue-cycle oversight, grant management, workforce leadership, and the development of programs responsive to the needs of Tribal members and the communities served. The position also advises the Chief Executive Officer and Tribal Council on health policy, program performance, funding opportunities, and matters affecting the Tribe’s health care delivery system.

PRINCIPAL ACTIVITIES & RESPONSIBILITIES:

• Provides executive leadership and operational oversight for the Tribe’s medical, dental, behavioral health, pharmacy, prevention, community and public health, and other health-related programs and services.
• Leads the development, implementation, and evaluation of the Health Division’s strategic and operational plans in alignment with Tribal priorities, community needs, applicable laws, funding requirements, and recognized standards of care.
• Develops and implements program policies, procedures, and service-delivery standards consistent with Indian Health Service requirements, applicable Tribal health laws, accreditation standards, funding requirements, and recognized health care practices.
• Assesses the health and wellness needs of Tribal members and the communities served and develops programs, partnerships, and service-delivery models designed to address identified needs.
• Establishes short- and long-term departmental goals, performance measures, and accountability standards. Prepares reports, plans, presentations, and recommendations regarding Health Division performance, risks, priorities, and outcomes.
• Works in conjunction with the Deputy Chief Operating Officer – Health and appropriate Finance personnel to prepare and administer annual Health Division budgets.
• Monitors revenue, expenditures, staffing, grants, contracts, and financial performance to ensure responsible use of resources and compliance with Tribal fiscal policies and funding requirements.
• Ensures compliance with federal regulations and funding obligations associated with Tribal self-governance agreements, Indian Health Service funding, grants, contracts, third-party reimbursement, and other state and federal funding sources.
• Oversees grant development, administration, compliance, reporting, budgeting, and closeout activities for Health programs.
• Ensures grant-funded services are implemented in accordance with approved scopes of work, budgets, timelines, and funding requirements.
• Provides executive oversight of community and public health program development, including assessment, planning, implementation, evaluation, and expansion of prevention and population-health initiatives.
• Leads the development and buildout of community and public health services designed to address identified health disparities, prevention needs, communicable disease concerns, health education, emergency preparedness, and community wellness priorities. Oversee quality assurance, quality improvement, patient safety, risk management, infection prevention, utilization review, and regulatory compliance activities throughout the Health Division.
• Ensures clinical and preventative services are delivered in accordance with applicable professional standards, accreditation requirements, Tribal health laws, funding obligations, and culturally responsive practices serving American Indian and Alaska Native communities.
• Provides oversight of federal health programs, including compliance with applicable Health Resources and Services Administration, Indian Health Service, Centers for Medicare and Medicaid Services, 340B drug pricing program, state, grant, contract, and other regulatory requirements.
• Oversees the Tribe’s participation in the 340 B Drug Pricing Program, including covered-entity compliance, contract-pharmacy and third-party administrator oversight, audit readiness, program integrity, corrective-action planning, and ongoing monitoring.
• Provides executive oversight of revenue-cycle operations for medical, dental, behavioral health, pharmacy, and other billable Health Division programs.
• Ensures effective processes for registration, eligibility verification, payer enrollment, credentialing, coding, billing, claims management, payment posting, denials, collections, reimbursement, and accounts-receivable management.
• Identifies opportunities to strengthen current revenue streams, improve reimbursement, expand value-based payment arrangements, reduce revenue leakage, secure grant funding, and develop additional sustainable sources of revenue.
• Ensures appropriate systems are maintained for clinical credentialing and privileging, payer enrollment, professional licensing, exclusion monitoring, and other workforce compliance requirements.
• Oversees compliance with patient privacy, confidentiality, health-information security, records retention, and health-information management requirements.
• Oversees the effective use, maintenance, and security of electronic health records, clinical information systems, reporting systems, and other technology supporting patient care and Health Division operations.
• Coordinates with Information Systems and other departments to promote system reliability, data integrity, cybersecurity, privacy, and continuity of operations.
• Negotiates and maintains effective working relationships and contractual arrangements with Indian Health Service, other Tribes, governmental agencies, health systems, payers, vendors, contractors, consultants, and community partners.
• Monitors federal, state, and Tribal policy developments that may affect health services, reimbursement, funding, workforce requirements, or patient care and advises the Chief Executive Officer and Tribal Council as appropriate.
• Develops and maintains emergency-preparedness, disaster-response, public health response, and continuity-of-operations plans for the Health Division.
• Supervises, supports, and evaluates Health Division directors and senior leaders.
• Promotes accountability, collaboration, leadership development, succession planning, recruitment, retention, and consistent application of Tribal Policies throughout the Division.
• Works collaboratively with Tribal departments and programs to provide coordinated, culturally responsive, wraparound services to Tribal members and the community.
• Represents CTCLUSI on boards, committees, task forces, professional workgroups, and governmental or community partnerships as assigned by the Chief Executive Officer or Tribal Council.
• Maintains the highest standards of confidentiality, integrity, professionalism, ethical conduct, and respect in all interactions.
• Collaborates efficiently and effectively while consistently demonstrating professionalism and maintaining positive, respectful relationships with internal teams, external partners, and Tribal members.
• Other duties as directed by management.

LEVEL OF AUTHORITY & RESTRICTIONS

• An executive position with full decision-making authority within medical, dental, behavioral, pharmacy, and health prevention services.

PHYSICAL & MENTAL DEMANDS

• Requires the ability to manage moderate levels of stress arising from schedules, workload, diverse or adversarial stakeholders, etc.
• Must be able to walk, talk, hear, use hands to handle, feel or operate objects, tools, or controls, and reach with hands and arms.
• Vision abilities required by this job include close vision and the ability to adjust focus.
• May be required to push, pull, lift, and/or carry up to 40 pounds.
• Must be able to stand, walk, reach with hands and arms, and climb or balance.
• Must be able to sit and type for long periods of time.

WORKING CONDITIONS & ENVIRONMENT

• May require working occasional nights and/or weekends depending on events.
• Moderate noise level with frequent interruptions and distractions.
• Lighting conditions may be very bright or very dim.
• Must be willing and able to travel both locally and within the CTCLUSI service delivery area.

MINIMUM JOB REQUIREMENTS

• Must be 25 years of age or older per our vehicle use policy.
• A Master’s Degree in Business Administration, Health Services Administration, Public Health, related field or equivalent combination of education and experience.
• A minimum of seven (7) years of supervisory experience in multi-disciplinary health services administration or related field that demonstrates the knowledge, skills, and ability to perform the job.
• Experience administering the 340B Drug Pricing Program and working with IHS funding, Tribal health programs, and applicable Tribal health laws and regulations.
• Thorough knowledge of methods, techniques, and practices of health and human services delivery system administration of other Tribal Government related programming.
• Thorough knowledge of all laws and regulations governing health services to Indian Tribes.
• Knowledge of Indian Health Services programs.
• Experience with health care accreditation standards, such as AAAHC, CARF, COLA, or similar accrediting organizations.
• Strong financial management experience, including budgeting, strategic planning, grant administration, and revenue cycle oversight.
• Must complete National Incident Management System (NIMS) training for NIMS certification as arranged by the Tribes.
• Must have a valid driver’s license and be able to be insured to drive Tribal Government vehicles.
• Experience and proficiency in the use of Microsoft products (Excel, Outlook, PowerPoint, Word, etc).
• Ability to communicate clearly and effectively in English, verbally, in writing or by other acceptable means.
• This position is considered a covered role per the CTCLUSI Background Investigations Policy. A state criminal background check and fingerprint-based background check will be required as a condition of employment.
• This position is subject to pre-employment and other authorized drug and alcohol testing in accordance with company policy.
• Must have employment eligibility in the U.S.
• Indian preference will be observed in the hiring process.