Vice President Insurance Operations Jobs in Colorado

Under the supervision of the Chief Compliance Officer, the Vice President of Compliance is responsible for developing and maintaining a comprehensive compliance, audit management, and facility oversight plan for InnovAge PACE/LIFE Programs. The Vice President of Compliance leads the direction and management of compliance oversight including supervision of the audit management program and resources; supervision of the facility oversight program; development of policy and procedure management; implementation of compliance education and training, as well as initiation of compliance projects to ensure organizational integrity. The position supports the Chief Compliance Officer in fulfilling her/his oversight role by providing management, oversight, and assessment of the organization's clinical and operational practices compared to regulatory requirements. The Vice President of Clinical Compliance will be tasked with implementing corrective action plans (internal and external) to address risk areas identified.

Estimated Percent of time Spent – 100%

• Perform and manage audits of documentation, functions, and departments in all business lines to ensure adherence to regulatory guidance.
• Manage Regional Directors of Clinical Compliance, Audit Management; Director of Facility Oversight; Compliance Coordinator, and Augmented Audit staff as needed in alignment with the goals of the Compliance Department.
• Promote a culture of compliance across the enterprise by serving as a compliance expert resource.
• Oversee the organizational practices to assess compliance with regulations and government agencies regarding service documentation.
• Increase communications with providers, operations, and nursing to establish working relationships which encourage consistency with compliance practices and expectations.
• Lead discussions and develop projects to identify and mitigate compliance issues in practice areas.
• Ensure policies and procedures in the practice setting to ensure adherence to applicable laws, rules, and regulations.
• Participate in leadership meetings to promote compliance initiatives and respond to concerns raised.
• Promptly investigate reports of non-compliance or suspected violations of non-compliance and implement corrective actions as deemed appropriate.
• Assist with audit & compliance related special projects as requested.
• Develop audit processes and maintain audit tools for use in all lines of business.
• Collaborate with members of Corporate Compliance, as part of the compliance team, to share expertise and experience in building a culture of compliance across the organization.
• Remain current on federal and state regulations related to physician services and practices.
• Provide strong, clear verbal and written communication with an ability to convey complex ideas and information.
• Translate complex clinical mandates into operational workflows.
• Assists and leads compliance initiatives for State Ready Reviews (SRR) for new Centers.

Travel - estimated 40%

• Travel between InnovAge worksites
• Overnight travel out of state

• N/A

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• Resourceful, highly organized self-starter with a bias towards action and efficiency
• Trusted, team player looking to drive success in a fast-paced environment
• Solid computer skills, specifically using MS Word, Outlook, and Excel
• Excellent oral, written, and interpersonal communication skills, facilitation skills
• Data analysis and interpretation aptitude
• Innovative problem-solving skills
• Excellent presentation skills for both clinical and non‑clinical audiences
• Assists and leads compliance initiatives for State Ready Reviews (SRR) for new Centers.

• Eight to Ten years of experience across clinical compliance and/or regulatory functions in a healthcare delivery or healthcare environment
• Three to five years of experience managing enterprise level employees and/or teams
• Three to five years of experience conducting investigations to determine regulatory compliance
• Experience with integration of clinical, operations, and financial data; development of audit, utilization and performance reporting tools; and communication of performance data to healthcare stakeholders
• Experience with telecommuting and remote monitoring

• Familiar with navigating the electronic medical record (EMR) systems to complete reviews
• Strong analytical skills
• Works well with numbers, using basic math skills
• Formidable team player
• Ability to work with multiple and diverse clients and projects
• Ability to work with minimal supervision

• Must have a state‑issued driver’s license, personal transportation, safe driving record, and auto insurance as required by law
• Bachelor of Science / related field, or equivalent years of experience
• Nursing License, RN, preferred, or clinical equivalent
• Certification in Healthcare Compliance (CHC) preferred

InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.

Applicants are considered until the position is filled.

$200,000 - $240,000

The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity. InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays.

This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse.

For more information, please visit the Clearinghouse Education and Awareness website: https://info.flclearinghouse.com