Manager, Compliance Practices Oversight (Remote)
About the position
The Compliance Practices Oversight Manager serves as a liaison between the Compliance department and the Sales and Marketing functional departments and is the subject-matter-expert (SME) for guidance on Content Compliance needs and content submission processes for regulatory needs. This team supports compliance audits, implementing corrective action plans (CAPs), supporting legal requirements and needs, and provides metrics/KPI's on compliance, contract and policy requirements. The qualified candidate will have a breadth of experience across both managed care operations functions and execution of compliance practices.
Responsibilities
• Works closely with the Legal, Government Contracts and Compliance departments to ensure proper interpretation of new rules and regulations.
• Ensure implementation of federal and state requirements for Medicare and Medicaid for health plan content and for assigned defined projects and programs.
• Lead impact assessments and define work plans to ensure compliance when policies and regulations change.
• Lead the department in ongoing work related to policy and procedure documentation, revision, and maintenance.
• Collect and validate data/sample/documentation requests; review preliminary findings with stakeholders and prepare/deliver responses.
• Work with SMEs to document the CAP and ensure resolution; lead the team and track deliverables to ensure timely completion.
• Report on department policy and compliance KPIs.
• Manage the strategic direction for the Compliance Practices Oversight team, ensuring the Marketing team is enabled to achieve and maintain consistent compliance across all requirements.
• Establish the strategic direction, mission, and vision for the Compliance Practices Oversight team.
Requirements
• BA/BS or equivalent experience.
• 5+ years experience with managed healthcare operations.
• 3-5 years process development/improvement experience.
• 3+ years people leadership.
• Strong analytical skills.
• Strong problem-solving and critical thinking skills.
• Highly organized and detail oriented with proof-reading and quality control skills.
• Strong interpersonal, written and verbal communication skills.
• Strong technical skills using Microsoft Applications (i.e. Outlook, Word, Excel, and PowerPoint) and other databases and tools as needed.
• Previous experience working with the Centers for Medicare and Medicaid Services (CMS) Health Plan Management System (HPMS).
Nice-to-haves
• Graduate studies.
• PMP, SixSigma, or equivalent certification.
Benefits
• Competitive benefits and compensation package.
Apply Now
Apply Now
The Compliance Practices Oversight Manager serves as a liaison between the Compliance department and the Sales and Marketing functional departments and is the subject-matter-expert (SME) for guidance on Content Compliance needs and content submission processes for regulatory needs. This team supports compliance audits, implementing corrective action plans (CAPs), supporting legal requirements and needs, and provides metrics/KPI's on compliance, contract and policy requirements. The qualified candidate will have a breadth of experience across both managed care operations functions and execution of compliance practices.
Responsibilities
• Works closely with the Legal, Government Contracts and Compliance departments to ensure proper interpretation of new rules and regulations.
• Ensure implementation of federal and state requirements for Medicare and Medicaid for health plan content and for assigned defined projects and programs.
• Lead impact assessments and define work plans to ensure compliance when policies and regulations change.
• Lead the department in ongoing work related to policy and procedure documentation, revision, and maintenance.
• Collect and validate data/sample/documentation requests; review preliminary findings with stakeholders and prepare/deliver responses.
• Work with SMEs to document the CAP and ensure resolution; lead the team and track deliverables to ensure timely completion.
• Report on department policy and compliance KPIs.
• Manage the strategic direction for the Compliance Practices Oversight team, ensuring the Marketing team is enabled to achieve and maintain consistent compliance across all requirements.
• Establish the strategic direction, mission, and vision for the Compliance Practices Oversight team.
Requirements
• BA/BS or equivalent experience.
• 5+ years experience with managed healthcare operations.
• 3-5 years process development/improvement experience.
• 3+ years people leadership.
• Strong analytical skills.
• Strong problem-solving and critical thinking skills.
• Highly organized and detail oriented with proof-reading and quality control skills.
• Strong interpersonal, written and verbal communication skills.
• Strong technical skills using Microsoft Applications (i.e. Outlook, Word, Excel, and PowerPoint) and other databases and tools as needed.
• Previous experience working with the Centers for Medicare and Medicaid Services (CMS) Health Plan Management System (HPMS).
Nice-to-haves
• Graduate studies.
• PMP, SixSigma, or equivalent certification.
Benefits
• Competitive benefits and compensation package.
Apply Now
Apply Now