Senior Manager, Compliance – Health Plan/MCO Experience

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $94.1k - $164.8k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Provide compliance oversight and organizational leadership related to compliance • Proactively collaborate with partners and provide insights from analyses • Lead a team developing and maintaining State and Federal Regulatory Guidebooks, job aids, tools, and resources • Serve as a compliance leader in the Marketplace, Medicare, and Medicaid arena • Manage Federal and State regulator relationships and oversee regulator meeting agendas, execution, and follow-up • Oversee compliance activities, including inquiry management, complaint management, regulatory distribution, and compliance workplan execution • Lead Marketplace, Medicare, and Medicaid Compliance Committees and workgroups • Oversee policies, procedures, and standard operating procedures for regulatory, statutory, corporate, and contractual compliance • Monitor Federal and State laws, regulations, compliance practices, and industry standards • Provide risk feedback to Compliance leadership for annual compliance risk assessments • Assist with compliance workplan execution, regulatory audits, audit readiness, and reporting validation • Respond to compliance incidents and oversee reporting, communication, corrective actions, and remediation • Oversee compliance activity tracking and reporting to internal and external stakeholders • Support escalated external-entity issues and develop training programs to address compliance knowledge gaps • Provide compliance training to internal and external stakeholders • Collaborate with Market and Corporate leadership and business departments on compliance program management • Maintain relationships with State and Federal regulators • Provide subject matter expertise for market and enterprise initiatives • Keep leadership informed of regulatory initiatives, compliance concerns, operational issues, corrective actions, and remediations • Develop, recruit, retain, and manage compliance staff • Supervise staff, provide performance management feedback, and address disciplinary issues • Train current and new staff and develop training materials • Keep management apprised of team performance, projects, and issues • Perform other duties as requested

🎯 Requirements

• 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 • Strong health plan/MCO compliance and AI experience preferred • 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 • 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 • Required to travel to market office(s) on occasion • No licensure or certification required

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Total well-being support

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