The Manager of the Corporate Compliance Department is an administrative position with responsibility in providing direction for corporate compliance activities for Region 10.

• Serve as Corporate Compliance Officer
• Develop and Implement the PIHP Annual Compliance Plan
• Manage the Region 10 PIHP Compliance Program
• Supervise Compliance Department
• Serve as Chair of the PIHP Regulatory Compliance Committee Meetings
• Participate on Statewide Compliance Officers Workgroup
• Attend MDHHS / OIG Meetings
• Oversee MDHHS-OIG Program Integrity Reporting including:
  • Ensure quarterly submissions are timely
  • Ongoing communication to staff and Network regarding updates (as needed)
  • Education to staff and Network regarding updates (as needed)
• Provide oversight for Corporate Compliant Complaint Review and Investigation
  • Including OIG Referrals, provider fraud referrals, claims verification, site visits and complaint reporting
• Chair PIHP Corporate Compliance Committee
• Oversight all compliance investigation
  • Develop data analytic strategies for detecting fraud and abuse
  • Tract data
• Provide Oversight:
  • Primary Source Verification
  • Business Associate Agreements
  • Policy development and reviews
  • Conflict of Interest
• Oversee external quality reviews in the area of Compliance
• Meet with regional Corporate Compliance Officers

· Master’s Degree in behavioral health or related field

· Experience in the area of Corporate Compliance

· Two years of experience supervising staff

· Experience working at Pre-Paid Inpatient Health Plan (PIHP), Community Mental Health (CMH) or SUD provider agency

· Experience with privileging and credentialing

· Knowledge of the Michigan Medicaid Provider Manual

· Experience in writing reports, analyzing data and administrative projects

· Ability to be a “work leader” (of a person or function), or advise others

· Experience in managing projects and teams

· Excellent organizational and writing skills

· Demonstrated knowledge of Microsoft Word and Excel

· Ability to exercise some flexibility in problem solving, when expected results are clear and generally set by others, provided certain outcomes are avoided

· Ingenuity is required to adapt, alter, or improvise alternatives when unexpected situations occur

· Ability to exercise discretion and some flexibility in selecting an optimal solution from established alternatives to obtain the desired outcome

· Ability to use or exert influence in a work process

· Ability to provide, exchange or explain information which conveys an opinion or evaluation of the facts or analyses

· Ability to develop and/or maintain effective work relationships with new, established, or non-receptive individuals/organizations through tact, diplomacy, and persuasion

· Basic knowledge of MDHHS reporting

· Basic knowledge of State of Michigan Medicaid Provider Manual

· Valid State of Michigan Driver’s License

· Must have access to transportation

· Five years of experience supervising staff

· Five years of experience working in Corporate Compliance

· Experience with Microsoft PowerPoint

· Advanced knowledge of MDHHS PIHP/CMH reporting

· Advanced knowledge of State of Michigan Medicaid Provider Manual