Manager Risk & Compliance Management

Company :Highmark HealthJob Description : 

JOB SUMMARY

This job is responsible for the day-to-day direction of all risk and compliance assessment activities of Highmark Health across a broad range of frameworks including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, etc.  The incumbent will partner with the organizational risk and business partners, the technology organization, and global delivery teams to meet Highmark Health’s mission requirements in a manner consistent with the enterprise risk appetite.  The incumbent must have a proactive mindset and approach, and feel comfortable working in a highly matrixed environment.  

ESSENTIAL RESPONSIBILITIES

• Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.

• Establishes the appropriate methodology to be used and procedures to be performed for third-party risk, technology, operational compliance, and security programs, across a broad range of frameworks including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, etc.  This includes establishing necessary statistical sampling and utilizing various auditing methodologies.

• Coordinates and manage audits of departments across the enterprise to ensure compliance with policies, schedule, scope and accuracy with the latest laws and regulations, accuracy and completeness, business unit compliance, program training and communications delivery.

• Partners with functional subject matter experts around the organization, develops annual plan to address third-party strategic, operational, security, reputational, and financial risks for the Organization's family of companies.

• Establishes and monitoris Key Performance Indicators (KPIs) to ensure risk assessments are completed in accordance with Service Level Agreements, privacy-security policies, contractual obligations.

• Manages program to perform on-site third party audits, regulatory reviews, vendor risk reviews,  and validates necessary remediations to ensure alignment to relevant compliance guidelines.  

• Negotiates on behalf of the organization in third-party, regulatory and/or compliance engagements to ensure appropriate security, audit, regulatory and operational risk terms are appropriately addressed.  Interact with vendor and business unit personnel at all levels and effectively communicate risks, expectations, and alternative strategies to mitigate the Organization's concerns over security, audit, and risk provisions.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or related field

Substitutions

• 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

• Master's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or related field

EXPERIENCE

Required

• 5 years of interaction with regulators, auditors, and oversight bodies

To Include:

• 3 years in a leadership role, preferably in an Audit or Compliance discipline in a Healthcare or Healthcare related industry

• 3 years overseeing privacy, risk, audit, and/or compliance teams

Preferred

• 3 years with contract negotiations

LICENSES or CERTIFICATIONS

Required (any of the following or obtained within 12 months of hire)

• Certified Public Account (CPA)

• Certified Information Security Auditor (CISA)

• Certified Information Privacy Professional (CIPP)

• Certified Information Systems Security Professional (CISSP)

Preferred

• None

SKILLS

• Demonstrate expert knowledge of business and technology processes, risk and control frameworks, and assessment methodologies, particularly as applied to healthcare (payer and provider) business processes.

• Knowledge of relevant regulatory guidelines, vendor management, sourcing and procurement, and completing assessments of vendors 

• Excellent resource and project planning capabilities, decision making skills, history of results-oriented delivery, and effective team building across a cross-campus and diverse team of management and staff. 

• Strong written and verbal communication skills for diverse audiences (senior management, board, peer, and team). 

• Strong relationship building skills and ability to influence with and without authority in a matrixed organization. 

• Developed leadership qualities with an ability to motivate and inspire a group of individuals to achieve superior results. 

• High capacity to think analytically, interpret information / observations, apply judgment and make effective, strategic decisions.

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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