Director Of Compliance & Performance Monitoring (Administrative Staff) - 20068603

BWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.

What You'll Be Doing:

• Oversees operations of the Compliance & Performance Monitoring unit responsible for vocational rehabilitation regulatory, managed care organization (MCO) reporting, MCO compliance, Employer Substance Use Prevention and Recovery (SUPR) program compliance, Operational Quality Assurance, and Operational Policy.
• Oversees Compliance management team's administration of Annual Monitoring Plan which monitors & regulates performance of pharmacy rebate aggregators, Pharmacy Benefit Managers (PBMs), MCOs, and ensures operational quality standards and policies are maintained.
• Creates and/or ensures monitoring plan, procedures, policies, quality assurance initiatives, and operational policy guidelines are carried out, identifies process improvements & recommends internal controls through issuance of Compliance Analysis Reports (CARs), Operational Quality Assurance reviews, and Operational Policy creation and updates.
• Accesses & controls high-level confidential & legal documents & provides confidential advice to front-line departmental managers; advises Division Chief, directors, PBMs & MCOs regarding monitoring processes, operational quality, and policy matters.
• Hires, promotes, disciplines, & terminates subordinate personnel as appropriate and/or necessary.
• Performs other unclassified & fiduciary duties & functions as required (e.g., development & delivery of complex presentations related to monitoring BWC, PBM, MCOs, operational quality assurance, and operational policy, makes presentations to Chief & other BWC executive staff).
• Makes presentations to Chief & other BWC executive staff regarding monitoring processes, operational quality, and policy matters.

Qualifications:

• Preferred: Bachelors or Master's in Business Administration, Public Administration, Accounting, Finance, Organizational Leadership or related field. Experience overseeing operational compliance to include adherence to policy and procedure.

• The ideal candidate for this position will possess a strong working knowledge of accounting principles, organizational policy, and quality assurance standards. Preference will be given to applicants who demonstrate experience with financial reporting and internal controls, as well as the ability to interpret and apply organizational policies and quality assurance practices within a compliance and performance monitoring environment. This expertise will support the unit's efforts to maintain operational excellence, ensure contractual compliance, and promote continuous improvement across all monitored programs.

Major Worker Characteristics:

Knowledge of: budgeting, accounting, management, labor relations, workforce planning, employee training & development, public relations, human relations, BWC & MCOs' policies & standard operating procedures; counseling; interviewing; business; state & federal law pertaining to PBMs & MCOs; vocational rehabilitation services; operational policy/procedure development, quality assurance standards, SUPR* management reports; monitoring programs; leadership.

Skill in: Medical bill adjudication software, MS Office, Data analytic software such as Tableau or Cognos.CoreSuite and CAM

Ability to: exercise personal & sound business judgment in variety of business scenarios; deal with many complex variables & determine specific action; use statistical analysis; complete complex position papers; maintain accurate records; originate routine business letters reflecting standard & non-standard policies & procedures; interview job applicants effectively; understand complex manuals & verbal instructions, technical in nature; prepare & deliver speeches before specialized audiences & general public; gather, collate & classify information about data, people or things; portray professional image & create friendly atmosphere as management staff member; maintain high degree of loyalty, trust & confidence.

(*) Developed after employment.

Unusual Working Conditions:

• This position is overtime exempt.

• THIS POSITION IS UNCLASSIFIED PERSUANT TO ORC 124.11(A)(9).

• Position requires travel; therefore, persons occupying this position must provide their own transportation and/or legally operate a state-owned vehicle.

• The final external applicant selected for this position will be required to submit to urinalysis prior to appointment to test for illegal drug use. An applicant with a positive test result will NOT be offered employment.

• The final applicant for this position must submit to and pass an extensive background check by the Ohio State Patrol prior to appointment.

• WEATHER ESSENTIAL EMERGENCY EMPLOYEE