[Hiring] Senior Manager, Compliance @CareSource

Role Description

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.

• 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:
  • Center for Consumer Information and Insurance Oversight (CCIIO)
  • Centers for Medicare & Medicaid Services (CMS) Federal account managers
  • Department of Insurance (DOI) State regulators
  • State Medicaid regulators
• Oversee all Marketplace, Medicare and Medicaid compliance activities performed and tracked by compliance staff including:
  • Internal business owner and external regulator inquiry management
  • State complaint management
  • Regulatory distribution management
  • Compliance workplan execution
• Lead and organize Marketplace, Medicare and Medicaid Compliance Committees and workgroups as applicable.
• 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.
• Provide feedback to Compliance leadership concerning key risks in Marketplace, Medicare and Medicaid.
• 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 collaborate 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 to Market leadership and other Corporate leadership.
• Establish and maintain positive working relationships with State and Federal regulators.
• 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.
• Develop, recruit, retain, and manage compliance staff to ensure that Marketplace, Medicare and Medicaid operational and strategic goals are met.
• 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; develop 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.

Qualifications

• 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.

Requirements

• 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.

Benefits

• Compensation Range: $94,100.00 - $164,800.00.
• 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.

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.