The position acts as the organization's Privacy Officer. Along with the Compliance Officer, the Privacy & Information Security Officer serves as the focal point for all Medi-Cal, Healthy Kids, Healthy Families, and Medicare Advantage compliance activities. The Privacy & Information Security Officer specifically leads the development, approval, implementation, evaluation and administration of the organization's privacy, and information security compliance programs. Additionally, the Privacy & Information Security Officer directs and manages all efforts related to Members' Rights, Fraud and Abuse, the Special Investigative Unit, the Policy and Procedure Review Committee, Marketing, Provider Network Services and Managed Care compliance. Responsible for administrative direction and leadership and manages complex compliance requirements spanning many functional areas in the organization for the requirements of Privacy, Information Security, Electronic Data Interchange Processes and Health Information Technology and co-chairs the Security and Privacy Oversight Committee . Provides leadership to managers, staff, technical experts, subcontractors, vendors and analysts focused on implementation and ongoing compliance with Privacy, Information Security, Electronic Data Interchange and other related business functions. This includes strategic planning, control, risk analysis research, quality assurance and communications to senior management.
The Privacy & Information Security Officer performs administrative and regulatory work managing all ongoing activities related to the development, implementation, maintenance of, and adherence to the organization's policies and procedures for all organizational business processes for internal and external entities. Demonstrated ability to influence outside of direct reporting relationships. Ensures all related initiatives in the organization are following required HIPAA & HITECH transaction, privacy and information security regulations, along with other organizational Compliance regulations. Manages the budget allocated to the cost center and to assures the budget is consistent with the budgetary program goals. Ensures all related strategic initiatives and new product lines in the organization are following required compliance (timely access, fraud, waste and abuse, member rights, privacy, information security and electronic data interchange, etc. regulations through collaboration and participation on various internal and external steering committees. Responsible for Plan Partner auditing and monitoring of the Privacy, Information Security and Electronic Transaction requirements, Member Rights, Provider Network Services, Managed Care and Marketing Services. Responsible for the management of RAÇstaff to ensure deliverables/projects are completed to meet the highest possible outcomes and standards in a timely and appropriate manner. Assists the Compliance Officer on special projects and other assigned projects as needed.
QUALIFICATIONS & REQUIREMENTS
EDUCATION: Required:
Juris Doctorate, Master's Degree in Health Administration, Public Administration, Public Health, Public Policy, or Business Administration or other related graduate level degree. Bachelor's Degree in Health Administration, Public Administration, Public Health, Business Administration or other related subject matter.
Preferred:
Extensive business operations content expertise along with audit, privacy, information security, regulatory affairs, EDI, and health information technology compliance experience. Solid and comprehensive investigative, ethics, fraud, waste and abuse experience and interpretation of related laws and regulations in government programs such as Medicare, Medi-Cal, etc.)
LICENSES/CERTIFICATIONS: Required:
Certified in HealthCare Compliance or Information Privacy Professional and/or certified as a Information Security Professional.
Preferred:
Certified Compliance & Ethics Professional
EXPERIENCE: Required:
5 -7+ years of healthcare administration, managed care, compliance, privacy and information security experience. Knowledge of managing large complex projects with project management and change management principles. Strong judgment skills and discretion utilized for highly confidential and sensitive investigative cases. Demonstrated leadership, managerial, communication, facilitation and presentation skills. Excellent verbal and written skills required. PC proficiency in Microsoft Professional Office.
Preferred:
Detailed knowledge of Medi-Cal program and other government health programs. Detailed knowledge of HIPAA Privacy, Information Security and Electronic Data Interchange, Health Information Technology regulations and related legislation, the federal and state laws, regulations and legislation impacting the organization's business functions with respect to policies, procedures, fraud, waste and abuse, member rights, etc. Demonstrated ability to train staff, providers and the Board of Governors.
FOREIGN LANGUAGES: Required:
N/A
Preferred:
Conversational Spanish
L.A. Care Health Plan - 13 months ago
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ASSISTANT NURSING DIRECTOR, ADMINISTRATION Los Angeles County Department of Human Resources -
Los Angeles, CA Los Angeles County Department of Human Resources - 10 hours ago
