Compliance Manager

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🌲 Oregon – Remote

🌲 Oregon – Remote

💵 $113.9k - $139.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

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CareOregon

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1994

🏥 Healthcare

📦 Logistics

🛡️ Insurance

Healthcare • Logistics • Insurance

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

📋 Description

• Provide leadership, oversight, and operational direction for assigned compliance and program integrity functions • Ensure adherence to regulatory, contractual, accreditation, and organizational requirements • Develop program goals, workplans, performance measures, reporting mechanisms, policies, procedures, and controls • Use data analytics, performance metrics, and trend analysis to identify risks and evaluate program effectiveness • Oversee monitoring, auditing, readiness, corrective action, investigation, and reporting activities • Identify and escalate compliance, operational, strategic, financial, and reputational risks • Maintain appropriate program policies, procedures, controls, documentation, reporting, and monitoring • Serve as a subject matter expert for assigned compliance programs • Directly perform complex compliance, oversight, monitoring, auditing, readiness, and program integrity activities • Lead strategic initiatives, assessments, investigations, and reviews • Balance program execution with workforce leadership and development • Manage the team and recommend team direction and goals • Identify staffing needs; recruit and hire using an equity, diversity, and inclusion lens • Plan, organize, schedule, and monitor work • Develop, communicate, and oversee team and individual goals • Train, supervise, motivate, coach, and develop employees • Ensure adherence to department and organizational standards, policies, and procedures • Evaluate employee performance, provide feedback, recognize strong performance, and address performance gaps • Perform supervisory tasks with Human Resources as needed • Support the organization’s mission, vision, values, and commitment to equity, diversity, and inclusion • Strive to meet annual business and strategic goals • Perform other duties as needed

🎯 Requirements

• Minimum 5 years of progressive experience in Medicare, Medicaid, Managed Care, Compliance, Regulatory Affairs, Audit, Program Integrity, Delegation Oversight, Risk Management, Healthcare Administration, or related functions • Minimum 3 years of experience facilitating, implementing, overseeing, or managing regulatory, contractual, compliance, audit, monitoring, oversight, readiness, corrective action, or risk management activities • Minimum 2 years of workforce leadership experience or demonstrated success leading complex cross-functional initiatives requiring influence without direct authority • Experience interacting with federal and/or state regulatory agencies, auditors, accreditation organizations, delegated entities, or oversight bodies • Experience using analytics, reporting, workflow, or other technology tools to support compliance oversight, program execution, decision-making, and continuous improvement • Strong knowledge of state and federal compliance plan requirements for Medicare and Medicaid Programs, including the Oregon CCO contract and applicable CMS online manual chapters • Proficient knowledge of OARs, CFRs, sub-regulatory guidance, and their purpose • Understanding of CMS-related managed healthcare operations • Understanding of contract law and maintenance of policies and procedures related to contracts • Working knowledge of the Patient Protection and Affordable Care Act • Solid understanding of information systems • Ability to perform or oversee risk assessments and/or gap analysis • Ability to manage and facilitate learning opportunities • Ability to make presentations to small and large groups • Ability to plan, organize, manage, and monitor work projects • Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day • Ability to hear and speak clearly for at least 3–6 hours/day • Preferred: minimum 2 years’ supervisory experience, or 1 year with completion of CareOregon’s Aspiring Leaders Program • Preferred: Bachelor’s degree in business, Health Care Administration, Analytics, Public Administration, or related discipline • Preferred: experience supporting CMS, OHA, NCQA, URAC, Health Share, or other regulatory and accreditation activities • Preferred: experience presenting to executive leadership, governance committees, or boards

🏖️ Benefits

• Bonus opportunity; SIP target of 5% annually • Medical, dental, vision, life, AD&D, and disability insurance • Health savings account • Flexible spending account(s) • Lifestyle spending account • Employee assistance program • Wellness program • Discounts and multiple supplemental benefits, including voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, and 529 College Savings • Retirement plan with employer contributions • PTO • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty leave • Bereavement leave • 401(k) contributions for non-benefits-eligible employees • Work from home

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