Sr. Clinical Compliance Manager

| San Francisco | Remote
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The Senior Clinical Compliance Manager will lead Included Health’s clinical and healthcare regulatory compliance. Primary objectives for this role include (i) supporting Clinical Excellence Team compliance with laws and standards relating to compliance with government programs, professional licensure, clinical scope of practice, and telehealth; (ii) researching regulatory developments impacting clinical operations and implementing processes to facilitate compliance with those regulations; (iii) developing and enforcing policies and procedures in conjunction with the Legal and Clinical teams; and (iv) operationalizing regulatory requirements to achieve the goal of compliance excellence. The Senior Manager of Clinical Compliance works closely with the Legal and Clinical Excellence Teams to support Included Health’s overall compliance program. 

 

Duties/Responsibilities:

  • Responsible for ensuring that Included Health is in compliance with relevant regulations, standards, and government program requirements (e.g. Medicare and Medicaid). 
  • Directs and oversees healthcare regulatory compliance for multiple provider types in partnership with Legal, including licensure and scope of practice, and advises Clinical Operations regarding the same.
  • Manages the internal audit program and controls to manage potential fraud, waste, and abuse risks.
  • Partners with key functional leaders such as Product and Engineering teams on operational considerations for new provider types and service offerings.
  • Oversees medical board investigations and external audit requests.
  • Works closely with the Clinical Team to implement and operationalize new processes relating to clinical compliance and risk management.
  • Communicates compliance initiatives and areas of risk across departments.
  • Identifies gap areas, updates clinical policies, and handles incident reporting.
  • Provides necessary HR training to comply with regulations and maintains record of historical training for government programs. 
  • Responsible for quarterly compliance updates for CCO/ Board of Directors review
  • Keeps abreast of regulatory developments within or outside of the Company as well as evolving best practices in compliance control.
  • All other duties as assigned. 

Required Skills/Abilities:

  • Clinical/regulatory experience in a healthcare setting.
  • Proactive collaborator who works as a true business partner across various Company teams.
  • Knowledge of regulatory bodies including but not limited to CMS, OCR, OIG, OSHA and state regulators.
  • Exceptional written, oral, interpersonal, and presentation skills and the ability to effectively interface with senior management and staff.
  • A commitment to the mission and values of the organization while demonstrating good judgment, flexibility, patience and discretion when dealing with confidential and sensitive matters.
  • Ability to work independently with little or no supervision.
  • Excellent time management skills with a proven ability to meet deadlines.
  • Strong analytical and problem-solving skills.
  • Ability to function well in a high-paced environment and able to quickly adapt to change.

Education/Experience:

  • Bachelor's degree, Master's degree preferred. 
  • 5-7 years of experience in a regulatory compliance role.
  • 4+ years of legal experience in general healthcare law.
  • Knowledge of federal and state laws relating to health care.

This is not necessarily an all-inclusive list of job-related responsibilities, duties, skills, efforts, requirements or working conditions. While this is intended to be an accurate reflection of the current job, Included Health reserves the right to revise the job or to require that other or different tasks be performed as assigned. All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities. This job description in no way states or implies that these are the only duties to which will be required in this position, employees may be required to follow other job-related duties as requested by their supervisor/manager (within guidelines and compliance with Federal and State Laws). Continued employment remains on an “at-will” basis.


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About Included Health


Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.


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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.

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Location

We are located in downtown SF close to many restaurants and public transportation options. And our biggest office perk: beautiful views of the bay.

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