Compliance Auditor, Delegation Oversight

At Umpqua Health, we're more than just a healthcare organization; we're a community-driven Coordinated Care Organization (CCO) committed to improving the health and well-being of individuals and families throughout our region. Our comprehensive services include primary care, specialty care, behavioral health services, and care coordination to ensure our members receive holistic, integrated healthcare. Our collaborative approach fosters a supportive environment where every team member plays a vital role in our mission to provide accessible, high-quality healthcare services. From preventative care to managing chronic conditions, we're dedicated to empowering healthier lives and building a stronger, healthier community together.

Umpqua Health strongly encourages applications from candidates of color as well as veterans, aiming to foster a work environment that is linguistically and culturally diverse and inclusive. Please note that at this time, Umpqua Health does not offer visa sponsorship.

The Role:

As a Compliance Auditor, Delegation Oversight, your responsibilities will include conducting thorough compliance monitoring of sub-contracted organizations, meticulously reviewing processes and documentation to ensure strict compliance with both regulatory and contractual requirements. You will lead audits and ongoing monitoring activities of delegated entities, analyzing data and providing valuable insights to enhance our compliance efforts. You will also be responsible for preparing comprehensive audit reports and presenting findings to relevant committees. Additionally, you will provide updates and recommendations to management on quality and delegation oversight responsibilities, participate in fraud, waste, and abuse investigations, and oversee pre-delegation and annual audits for new and existing delegated entities. Your meticulous attention to detail and expertise will drive continuous improvement and adherence to regulatory standards across the organization.

• Lead and manage compliance projects and initiatives, including risk assessments, policy development, and process improvement efforts.
• Plan, coordinate, and conduct comprehensive compliance audits and reviews to assess adherence to regulatory requirements, contractual obligations, and internal policies.
• Conduct risk assessments to identify compliance risks and develop strategies to mitigate risks and strengthen internal controls.
• Stay abreast of changes in healthcare regulations, laws, and industry standards; analyze regulatory developments and assess their impact on the organization.
• Develop and deliver compliance training programs for staff members, ensuring awareness of compliance requirements and promoting a culture of compliance throughout the organization.
• Investigate allegations of non-compliance, fraud, or misconduct; develop and implement corrective action plans to address identified issues and prevent recurrence.
• Prepare and present comprehensive reports and presentations to senior leadership and the Board of Directors, summarizing compliance activities, findings, and recommendations.
• Collaborate with cross-functional teams, including Legal, Risk Management, Quality Assurance, and Operations, to address compliance-related challenges and implement effective solutions.
• Assist in the development, review, and updating of compliance policies, procedures, and guidelines to ensure alignment with regulatory requirements and industry best practices.
• Establish key performance indicators (KPIs) and metrics to track compliance program effectiveness; monitor and analyze compliance data to identify trends and areas for improvement.
• Perform other duties as assigned by management needed to help drive to our Vision, fulfill our Mission, and abide by our Organization’s Values.

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or equivalent work experience.
• 3+ years of progressive experience in compliance, delegation oversight, or related roles within the healthcare industry.
• In-depth knowledge of federal and state laws, Medicaid regulations, and healthcare compliance standards.
• Exceptional analytical and problem-solving skills, with a meticulous attention to detail.
• Strong communication and collaboration abilities, with the capacity to engage effectively with stakeholders at all levels.
• Proficiency in Microsoft Office Suite and compliance software.
• Certified in Healthcare Compliance (CHC) or willingness to obtain certification within 12 months of hire.

Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.