Regulatory Compliance Analyst IV – Government Programs

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November 21

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CareCentrix

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Healthcare Insurance • Healthcare • Pharmaceuticals

CareCentrix is a healthcare company that simplifies care coordination and home benefit management, enabling health at home for members. By focusing on personalized care and utilizing their proprietary HomeBridge platform, they identify and engage members transitioning from hospital to home, ensuring timely delivery of appropriate services. CareCentrix's whole-person approach aims to improve outcomes, lower costs, and enhance both member and provider satisfaction through a high-quality provider network and data-driven analytics.

1001 - 5000 employees

Founded 1996

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2011-09

📋 Description

• Monitor and interpret federal and state laws and regulatory guidance affecting CareCentrix’s government programs. • Analyze changes and communicate updates—both written and verbal—to impacted business areas. • Provide cross-functional guidance in developing and updating policies, procedures, and operational processes. • Support implementation across operational teams. • Assist with compliance audits, including Medicare Part C program audits. • Obtain and maintain operational licenses as needed. • Support onboarding of new government program customers. • Drive continuous improvement by enhancing compliance tracking, trending, and reporting tools. • Conduct internal audits and identify opportunities for process improvement. • Design and deliver compliance training programs. • Mentor and train junior team members within the Compliance Department’s regulatory team.

🎯 Requirements

• Bachelor’s degree preferred; or a minimum of 7 years of experience in a managed care setting. • JD or paralegal experience is a plus. • 7+ years’ experience working with managed care laws impacting Medicare Advantage and/or managed Medicaid health insurers and delegated entities. • Proven experience in regulatory affairs and/or operations within HMOs, Managed Care Organizations, or government program health plans. • Advanced legal research, organizational, and analytical skills. • Strong written and verbal communication, including presentation skills and attention to detail. • Proficiency in MS Office Suite (Excel, SharePoint, PowerPoint, OneNote). • Deep understanding of Medicare Advantage guidelines and state regulations applicable to Managed Medicaid.

🏖️ Benefits

• Medical • Dental • Vision • 401(k) with company match • HSA employer contributions • Dependent Care FSA employer contribution • Paid Time Off • Personal/Sick Time • Paid Parental Leave • and more.