Senior Manager, Quality Assurance and Compliance

Job not on LinkedIn

October 26

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

🏄 California – Remote

Although this job is listed in California, this company may be open to hiring remote in other states.

+3 more states

🌵 Arizona – Remote 🏄 California – Remote 🎰 Nevada – Remote 🌶️ New Mexico – Remote 🤠 Texas – Remote

💵 $125.4k - $181.4k / year

⏰ Full Time

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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SCAN

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Healthcare Insurance • B2C

SCAN is a mission-driven healthcare organization focused on reinventing aging by delivering evidence-based, patient-centered care and coverage for older adults. It operates an integrated portfolio including health insurance plans with innovative benefits, in-home and virtual primary care, support programs for caregivers and homebound older adults, and specialized services for vulnerable populations. SCAN also invests in and partners with companies that advance care models and resources to help older adults remain healthy and independent at home.

1001 - 5000 employees

Founded 1977

⚕️ Healthcare Insurance

👥 B2C

📋 Description

• Responsible for developing and implementing a quality assurance program • Reviewing audits to meet accuracy, timeliness and contractual obligations • Enhancing operational processes • Partnering with Ops leadership to design and develop an effective Quality Assurance and Compliance program • Gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process • Managing quality and Compliance reporting • Coordinating accurate and timely submission of data, including audit readiness and documentation standards for Operations • Collaborating with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction • Monitoring and communicating performance trends to track and analyze key performance indicators (KPIs) • Sharing actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation • Establishing an effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance • Leading a team of quality assurance and compliance professionals • Mentoring, fostering positive team culture, promoting leadership growth, encouraging innovation, and continuous learning to achieve team or individual goals • Identifying trends and areas of opportunity for process improvements and additional training • Working closely with operations leadership to review findings, develop action plans and remediate issues • Monitoring industry trends, regulatory changes and current events to ensure the team remains informed and adapts to evolving policies and procedures

🎯 Requirements

• Bachelor’s Degree required • Graduate or Advanced Degree or equivalent experience preferred • Audit Certification preferred • 5 years of related experience in QA and compliance operations experience with Medicare and Medicaid • 3+ years’ management experience in healthcare environment, preferably Medicare Advantage • 8+ years of progressive experience in healthcare operations • Experience managing Quality Assurance and/or Operations audit team • Experience working with AI or other machine learning tools to assist with streamlining QA processes • Deep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievances • Proven success leading quality and compliance in a matrixed environment • Strong working knowledge of CMS and state regulations and operational implications

🏖️ Benefits

• An annual employee bonus program • Robust Wellness Program • Generous paid-time-off (PTO) • Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday • Excellent 401(k) Retirement Saving Plan with employer match and contribution • Robust employee recognition program • Tuition reimbursement