Senior Compliance Administrator – Clinical, SNP Model of Care, Care Management, Quality, STARs

This is a fully remote position, open to applicants in Connecticut, +10 more states.

📋 Description

• Assist in the daily implementation of the Medicare Compliance Advisory program in accordance with CMS guidelines and relevant federal and state regulations.

• Offer regulatory advice, perform research and analysis, monitor issues, aid in audit preparedness, and support compliance workplan initiatives.

• Implement the Medicare Compliance Program to avert, identify, and rectify noncompliance as well as fraud, waste, and abuse (FWA).

• Convert federal, state, and contractual requirements into practical compliance guidance.

• Create and manage regulatory communications, encompassing inquiry responses, issue summaries, and disclosures.

• Assist in the preparation, validation, and submission of regulatory reports, attestations, and filings.

• Recognize compliance risks, evaluate business-process exposure, provide risk stratification, and suggest mitigation strategies.

• Lead or assist in identifying issues, conducting root cause analyses, and developing corrective action plans.

• Offer subject matter expertise for audits and monitoring efforts.

• Aid in audit execution, regulatory assessments, and ongoing audit preparedness.

• Assess remediation plans and validate corrective measures.

• Participate in compliance training and mentor stakeholders on regulatory requirements and best practices.

• Review policies, procedures, and business processes for alignment with regulatory and contractual obligations.

• Lead or contribute to cross-functional projects that enhance compliance processes and operational efficiency.

• Monitor regulatory changes and industry trends to identify potential risks.

• Collaborate with compliance, legal, audit, and operational teams.

• Perform additional duties as assigned and adhere to all policies and standards.

⛳️ Requirements

• Bachelor’s degree in a relevant field (e.g., healthcare administration, public health, policy) or equivalent experience is required.

• 5+ years of experience in Compliance, regulatory, operations, or risk management within a regulated industry.

• 4+ years of Compliance advisory experience, including regulatory research and drafting compliance guidance, risk assessment, issue tracking, auditing/monitoring, and overseeing corrective action plans.

• 2+ years of experience supporting managed care, Medicare Advantage/Part D, or Dual Eligible (DSNP) programs.

• Fundamental understanding of Medicare regulations, including CMS guidelines and compliance expectations (e.g., Parts C & D).

• Excellent written and verbal communication abilities.

• Strong analytical, organizational, and documentation skills with a keen attention to detail.

• Capability to handle multiple assignments and meet deadlines in a dynamic work environment.

• Certification in Healthcare Compliance (CHC) is preferred.

• Familiarity with CMS audit protocols, program audits, or monitoring activities is preferred.

• Experience in a matrixed or cross-functional environment is preferred.

• Related or relevant licensure (e.g., RN, LPN, Pharmacist, CPhT, Case Management) is preferred.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in total compensation.

• Equal opportunity employer dedicated to diversity.