Ensure your organization reviews and recommends revisions to the Health Plan Compliance Program and Compliance Policies and Procedures as appropriate to respond to changes in your organizations needs and applicable legal requirements, identified weaknesses in the Program, or identified systemic patterns of noncompliance.

More Uses of the Risk Management and Compliance Toolkit:

  • Confirm your organization directs programs, policies, and practices to ensure that assigned business units are in compliance with applicable regulatory requirements and the internal policies and procedures of your organization.
  • Be a leader for risk management and compliance with multiple high growth Marketing product area teams with a focus on end to end spend governance and driving value for spend.
  • Confirm your organization develops and ensures the implementation of your organizations policies and procedures related to ongoing monitoring and improvement of quality care and to ensure policies meet regulatory requirements.
  • Ensure your organization prepares complex, comprehensive, risk based review of existing and emerging regulatory requirements and provides prompt, focused feedback to business management on concerning issues and control gaps.
  • Ensure your organization business priorities are built around the need to strengthen and guard your organization from the many risks you face, financial rigor, risk discipline, fostering a transparent culture and doing the right thing in every situation.
  • Ensure your organization defines and implements a risk based approach to identifying, monitoring, measuring and reporting various types of security risk and compliance issues in regards to financial reporting.
  • Ensure you understand current and expected changes to business strategy and related regulatory implications to business, and continually update compliance processes, procedures and policies accordingly.
  • Provide security consulting services in identifying, assessing, managing, and tracking remediation of risks related to IT infrastructure, applications, platforms and suppliers and drive explicit requirements and timelines in all environments.
  • Ensure your organization brings regulatory changes and matters of significance or urgency to the attention of the CCO and/or Departmental Executives and facilitates needed changes for compliance or to improve business practices.
  • Be accountable for ensuring that all new employees receive information on health and personal safety in the workplace; emergency evacuation procedures and routes; and resources for reporting or obtaining additional information about health, safety, and related matters.
  • Perform deep dive review of areas of emerging risk or potential control gaps to identify issues for the business to remediate; document and share analysis with business stakeholders entering issues and action plans organizations system of record.
  • Establish: partner with the business to continually improve operational risk processes and business operating models, support safe business growth, and inform and influence risk based decision making.
  • Ensure your organization oversees the overall credentialing process ensuring consistent and complete information gathering and review to monitor the quality of care provided by independent practitioners, as per facility policy.
  • Provide leadership, guidance, and oversight to ensure the implementation and consistent operation of an information security governance, security risk management and compliance program.
  • Be accountable for ensuring adequate coverage of significant risks through delegation of resources for monitoring and review of standard reports, risk model analysis and associated field work.

 

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