Shire Jobs

PRINCIPLE RESPONSIBILITIES:

Principle responsibilities include:

TheSr.Director of Enterprise Risk Management and Operational Oversight is responsible for developing, implementing, and overseeing the enterprise-wide risk management program for Alameda Alliance for Health. This role will lead the identification, assessment, and mitigation of risks across the organization, ensuring compliance with regulatory requirements and alignment with business objectives. TheSr.Director will manage risk management and operational oversight through annual risk assessment development and mitigation/monitoring activities, monitoring completion of corrective action plans, management of marketing and member material oversight and fulfillment, management of analysis of regulatory changes, communication and implementation, management of business continuity and disaster recovery initiatives, and manage Compliance Department liaisons with business units.

Principal responsibilities include:

• Develop and maintain an enterprise-wide risk management framework and strategy
• Lead the implementation and ongoing management of risk assessment processes across all business units
• Collaborate with senior leadership to integrate risk management into strategic planning and decision-making processes
• Design and implement risk reporting mechanisms to provide timely and accurate information to stakeholders
• Oversee the development and maintenance of risk registers and risk mitigation plans
• Facilitate risk workshops and training sessions to promote a culture of risk awareness throughout the organization
• Monitor emerging risks in the healthcare industry and assess their potential impact on the organization
• Ensure compliance with relevant regulatory requirements and industry standards, including Medicare, Medicaid, and state-specific regulations
• Manage relationships with external auditors, regulators, and other stakeholders regarding risk management matters
• Lead and mentor a team of 7-20 risk management professionals, including managers, analysts, and specialists
• Support the Chief Compliance Officer in development of strategic plans for improvement of Compliance Department Operations
• Develop policies and procedures for assigned service areas
• Conduct periodic enterprise training regarding risk management and operational oversight
• Serve on internal committees and workgroups as assigned by the Chief Compliance Officer
• Prepare executive summaries and reports, develop and conduct training activities for subordinates, peers and business units
• Lead or participate in interdisciplinary teams

ESSENTIAL FUNCTIONS OF THE JOB:

• In-depth knowledge of enterprise risk management frameworks and methodologies
• Thorough knowledge of healthcare regulations, including Medicare and Medicaid requirements
• Strong understanding of the healthcare industry, including regulatory landscape and emerging trends
• Knowledge of health plan management, compliance, finance, accounting, assurance and control principles
• Proficiency in risk management software, data analysis tools, and standard office applications (e.g., Microsoft Office suite)
• Excellent analytical and problem-solving skills
• Outstanding communication and presentation abilities
• Proven leadership and team management experience, with the ability to effectively manage a large team
• Demonstrated project management, organization and facilitation skills
• Strategic thinker with business risk awareness
• High level of personal integrity, and the ability to professionally handle confidential matters
• High level of tact and ability to communicate complex and potentially sensitive issues to various levels of management
• Ability to influence and collaborate with senior executives and cross-functional teams
• Ability to effectively prioritize and execute tasks in a high-pressure environm nt
• Ability to read, analyze, and interpret complex documents
• Ability to respond effectively to sensitive inquiries or complaints
• Ability to write speeches and articles using original or innovative techniques or style
• Ability to make effective and persuasive speeches and presentations on controversial or complex topics to top management, public groups, and/or boards of directors
• Ability to work with mathematical concepts such as probability and statistical inference
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
• Ability to define problems, collect data, establish facts, and draw valid conclusions
• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables

PHYSICAL REQUIREMENTS:

• Constant and close visual work at desk or computer;
• Constant data entry using keyboard and/or mouse;
• Constant sitting and working at desk;
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person;
• Frequent lifting of folders and various objects weighing between 0 and 30 lbs;
• Frequent walking and standing;
• Occasional driving of an automobile;
• Occasional travel between offices for meetings; and
• Possible travel by aircraft.

Number of Employees Direct Supervision:2-7

Number of Employees In-Direct Supervision:10-20

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Bachelor's degree in Business Administration, Finance, Healthcare Administration, or a related field required.
• Master's degree in a relevant field preferred.
• Professional certifications such as CRMA, CRISC, ARM, or healthcare-specific certifications highly desirable.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Minimum of 7 years of experience in risk management, with at least 3-5 years in a leadership role.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

Required: Substantial experience in health plan compliance or operations.

Preferred: Experience working with Medicare, Department of Health Care Services (DHCS), or Financial Management Group Certification (FMGC) programs.

Proven track record of developing and implementing enterprise risk management programs in a healthcare setting.

Experience working with regulatory bodies and managing compliance requirements in healthcare.

Demonstrated ability to lead and manage teams of varying sizes, preferably in the range of 7-20 direct reports.

Strong understanding of managed care operations and/or compliance requirements preferred.

Excellent interpersonal skills and can work effectively with staff at all levels.

Ability to communicate effectively and provide constructive feedback.

Proficient in developing and maintaining tracking and reporting tools for compliance assessment.

In-depth knowledge of enterprise risk management frameworks and methodologies.

Strong understanding of the healthcare industry, including regulatory landscape and emerging trends.

Excellent analytical and problem-solving skills.

Outstanding communication and presentation abilities.

Proven leadership and team management experience, with the ability to effectively manage a large team.

Ability to influence and collaborate with senior executives and cross-functional tea