Job Description

Welcome to Nevada Behavioral Health Systems

NBH has developed a comprehensive, community-based system of care by contracting with experienced providers offering evidence-based services. We contract with a wide variety of behavioral health care providers to respect and ensure member choice and to meet the special health care needs of our members.

Job Purpose

The Compliance Officer is responsible for overseeing and implementing compliance programs to ensure adherence to state and federal regulations, including Medicare, Medicaid, and accrediting bodies such as DNV, Joint Commission, and CARF. This role ensures contractual obligations are met, including turn-around times and network adequacy requirements, while fostering a culture of integrity and ethical practices. The Compliance Officer will also serve as the HIPAA Privacy Officer, ensuring the organization's adherence to privacy laws and regulations. Additionally, this role will assist with HR-related compliance matters, including compliance with state and federal employment regulations, employee investigations and reporting mechanisms for workplace concerns.

Responsibilities

• Develop, implement, and maintain compliance programs to ensure adherence to federal and state regulations, including HIPAA, Medicare, Medicaid requirements.
• Monitor changes in regulations and ensure timely updates to internal policies and procedures.
• Ensure compliance with accrediting body standards, including but not limited to DNV, Joint Commission, and CARF.
• Oversee adherence to contractual requirements such as turn-around times, network adequacy, and performance benchmarks.
• Conduct regular audits and risk assessments to identify potential compliance vulnerabilities and develop mitigation strategies.
• Collaborate with cross-functional teams to ensure compliance requirements are integrated into daily operations.
• Serve as the primary contact for external audits and regulatory inspections.
• Provide education and training to staff on compliance policies, regulatory updates, and best practices.
• Investigate and resolve compliance-related issues, including coordinating corrective action plans when necessary.
• Develop and maintain a comprehensive compliance reporting system to track key performance indicators and incidents.
• Partner with quality assurance teams to align compliance efforts with organizational quality initiatives.
• Promote a culture of compliance and ethical practices across the organization.
• Ensure compliance with state and federal employment laws and assist with employee investigations related to compliance and HR issues, ensuring fair and thorough processes.
• Establish and oversee a hotline or other reporting mechanism for employees to anonymously report concerns and potential violations.
• Act as the HIPAA Privacy Officer, ensuring compliance with patient privacy laws and regulations and managing privacy-related investigations and risk mitigation efforts.

Qualifications Education and Experience

• Bachelor’s degree in Health Administration, Law, Business, or a related field; Master’s degree preferred.
• 5+ years of experience in compliance and quality assurance roles, with a focus on healthcare regulations.
• Strong knowledge of Medicare, Medicaid, and multi-state regulatory requirements.
• Experience with accrediting bodies such as DNV, Joint Commission, and CARF.
• Familiarity with contract compliance, including network adequacy and performance standards.

Preferred Qualifications

• Certified in Healthcare Compliance (CHC) or equivalent certification.
• Experience in managed care or behavioral health compliance programs.
• Knowledge of quality management systems and metrics.

Job Tags

Similar Jobs