Senior Manager, Compliance (Health Plan/MCO experience required)

Job Summary:

The Senior Manager, Compliance provides compliance oversight, organizational leadership related to compliance, ensures the department proactively collaborates with partners, provides insights from analyses being conducted and leads a team that develops and maintains comprehensive State and Federal Regulatory Guidebooks, job aids, and other tools and resources needed to support wide-spread compliance in delegated and non-delegated Marketplace (Qualified Health Plan), Medicare and Medicaid services as applicable to the Senior Manager’s specific product oversight. Strong health plan/MCO compliance and AI experience preferred.

Essential Functions:

Serve as a compliance leader in the Marketplace, Medicare and Medicaid arena as applicable

Manage the Federal and State regulator relationships including but not limited to the Center for Consumer Information and Insurance Oversight (CCIIO) and Centers for Medicare & Medicaid Services (CMS) Federal account managers, Department of Insurance (DOI) State regulators and State Medicaid regulators (collectively “regulators”) and oversee the development, execution, and follow-up for regulator meeting agendas

Oversee all Marketplace, Medicare and Medicaid compliance activities performed and tracked by compliance staff including, but not limited to, internal business owner and external regulator inquiry management, State complaint management, regulatory distribution management, and compliance workplan execution

Lead and organize Marketplace, Medicare and Medicaid Compliance Committees and workgroups as applicable, representing both State and Federal updates across all markets

Oversee Marketplace, Medicare and Medicaid policies and procedures (P&P) and standard operating procedures (SOP) to ensure compliance with Federal and State regulatory, statutory, corporate, and contractual standards and obligations

Remain current in Federal/State laws and regulations regarding Marketplace, Medicare and Medicaid requirements as well as general compliance and delegation oversight best practices and industry standards

Provide feedback to Compliance leadership concerning key risks in Marketplace, Medicare and Medicaid so that Compliance leadership may complete the annual compliance risk assessment

Assist with the execution of the compliance work plan

Respond to compliance incidents and ensure appropriate reporting and communication with business leaders and compliance team members

Provide feedback and recommendations for ongoing monitoring or improvement to the Compliance Corrective Action Team regarding corrective action plans

Oversee and ensure that all Marketplace, Medicare and Medicaid compliance activity tracking is developed, maintained and reported to internal and external stakeholders

Assist with regulatory audits and support audit readiness activity

Assist with oversight of data validation of all internal and external compliance and regulatory reporting

Act as a resource for internal departments to assist with external-entity related escalated issues

Identify compliance knowledge gaps and collaborates with applicable business teams to develop training programs to address the gaps

Provide compliance training for all internal and external stakeholders to ensure compliance program effectiveness

Cultivate effective relationships, collaborate with, and provide Marketplace, Medicare and Medicaid compliance expertise including both State and Federal requirements to Market leadership, and other Corporate leadership and business departments to ensure effective compliance program management

Establish and maintain positive working relationships with State and Federal regulators ensuring to build goodwill and trust for CareSource as an entity

Provide subject matter expertise in support of Marketplace, Medicare and Medicaid market and enterprise initiatives

Ensure direct line leadership and the applicable Marketplace, Medicare and Medicaid business Leadership are informed of all material regulatory initiatives, compliance concerns, operational issues and associated corrective actions and corresponding remediations impacting CareSource

Develop, recruit, retain, and manage compliance staff to ensure that Marketplace, Medicare and Medicaid operational and strategic goals are met while maintaining compliance with company, State, Federal and contractual requirements for all lines of business

Supervise staff for successful execution of assigned duties, performance management feedback, and disciplinary issues

Train current and new staff members on departmental policies and procedures; develops staff training materials when necessary

Proactively keep the management team apprised of the team’s performance, projects and issues

Perform any other job duties as requested

Education and Experience:

Bachelor of Science/Arts degree or equivalent years of relevant work experience is required

Minimum of seven (7) years of healthcare compliance, managed care experience, vendor oversight, internal audit or equivalent experience is required

Minimum of three (3) years direct management experience required

Specific Marketplace, Medicare and Medicaid managed care experience is required as applicable for the Senior Manager’s product oversight

Competencies, Knowledge and Skills:

Ability to develop and foster effective collaborative relationships with market and enterprise management in a matrix environment

Strong conflict resolution, negotiating and influencing skills

Proficient in Microsoft Office Suite to include Word, Excel, Outlook, PowerPoint, SharePoint, and Visio

Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis

Leadership ability with a high level of professionalism

Familiarity with the managed care concepts, practices and procedures

Develops and maintains an expert knowledge of the company’s business and regulatory environments

Excellent problem solving and critical thinking skills

Effectively communicate in a matrix environment with excellent verbal, written, and presentation skills

Strong attention to detail

Excellent organization and time management skills

Ability to develop, prioritize and accomplish multiple goals

Strategic thinking and decision-making skills

Licensure and Certification:

None

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Required to travel to market office(s) on occasion

$94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Salary

Organization Level Competencies

- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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