Senior Manager, Compliance – Health Plan/MCO Experience

This is a fully remote position, open to applicants in United States.

📋 Description

• Ensure compliance oversight and provide organizational leadership related to compliance.

• Collaborate proactively with partners and share insights derived from analyses.

• Guide a team in the development and maintenance of State and Federal Regulatory Guidebooks, job aids, tools, and resources.

• Act as a compliance leader within the Marketplace, Medicare, and Medicaid sectors.

• Manage relationships with Federal and State regulators, overseeing meeting agendas, execution, and follow-up.

• Supervise compliance activities, including inquiry management, complaint management, regulatory distribution, and execution of the compliance workplan.

• Lead Compliance Committees and workgroups for Marketplace, Medicare, and Medicaid.

• Oversee policies, procedures, and standard operating procedures for regulatory, statutory, corporate, and contractual compliance.

• Monitor compliance practices, laws, and regulations at both Federal and State levels, as well as industry standards.

• Provide risk feedback to Compliance leadership for the annual compliance risk assessments.

• Assist in executing the compliance workplan, regulatory audits, audit readiness, and validation of reporting.

• Address compliance incidents, overseeing reporting, communication, corrective actions, and remediation efforts.

• Track and report compliance activities to internal and external stakeholders.

• Support escalated issues from external entities and create training programs to bridge compliance knowledge gaps.

• Deliver compliance training to both internal and external stakeholders.

• Collaborate with Market and Corporate leadership and various business departments on the management of compliance programs.

• Maintain effective relationships with State and Federal regulators.

• Offer subject matter expertise for market and enterprise initiatives.

• Keep leadership updated on regulatory initiatives, compliance concerns, operational challenges, corrective actions, and remediations.

• Develop, recruit, retain, and manage the compliance staff.

• Supervise staff, providing performance management feedback and addressing disciplinary matters.

• Train existing and new staff members while developing training materials.

• Keep management informed about team performance, ongoing projects, and issues.

• Perform additional duties as assigned.

⛳️ Requirements

• A Bachelor's degree in Science/Arts or equivalent relevant work experience is required.

• At least seven (7) years of experience in healthcare compliance, managed care, vendor oversight, internal audit, or a related field is required.

• A minimum of three (3) years of direct management experience is required.

• Specific experience in Marketplace, Medicare, and Medicaid managed care is required for the Senior Manager’s product oversight.

• Strong preference for candidates with health plan/MCO compliance and AI experience.

• Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, SharePoint, and Visio.

• Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis.

• Familiarity with managed care concepts, practices, and procedures.

• Ability to develop and maintain expert knowledge of the company’s business and regulatory environments.

• Excellent problem-solving and critical thinking abilities.

• Strong communication skills, both verbal and written, suitable for a matrix environment, along with presentation skills.

• Exceptional attention to detail.

• Outstanding organizational and time management skills.

• Capability to develop, prioritize, and achieve multiple goals.

• Strong strategic thinking and decision-making capabilities.

• Occasional travel to market offices is required.

• No licensure or certification is necessary.

🏝️ Benefits

• Potential for bonuses linked to individual and company performance.

• Comprehensive total rewards package.

• Support for total well-being.