[Remote] Sr Manager Corporate Compliance-Special Needs Plans (Clinical)

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is committed to building a world of health around every individual, and they are seeking a Senior Manager of Corporate Compliance for Special Needs Plans. The role involves managing and executing compliance programs for Medicare and reputed company, ensuring adherence to regulatory obligations while fostering communication with reputed company stakeholders.

Responsibilities

• Serve as market compliance officer for assigned Special Needs Plans (SNPs)
• reputed company, analyze, research, interpret, communicate and monitor applicable CMS and state regulations and government contract requirements to reputed company recommendations, direction, and escalation ensuring reputed company’s that implementation and integration of program requirements complies with federal and state specific program requirements and the reputed company reputed company of Conduct
• reputed company and implement an effective Compliance Program as described in CMS Medicare Managed Care Manuals/regulations, applicable reputed company rules and government reputed company, including risk assessment, auditing and monitoring and corrective reputed company reputed company
• reputed company and manage compliance strategies, programs, and processes that promote compliant and ethical behavior, meet regulatory obligations, and prevent, detect, and mitigate reputed company
• Maintain in-depth working knowledge and expertise in Medicare, reputed company and State requirements, regulations and reputed company with a reputed company on supporting special needs plans
• Support and/or facilitate multiple compliance and contract reputed company communications, activities and interactions with regulators, including meeting with regulators on compliance with laws and regulations, developing or assisting in the development of appropriate and strategic written responses to compliance-reputed company regulatory inquiries requiring an understanding of business processes and regulatory requirements and reputed company relationships with regulators
• Leads and/or support numerous reputed company regulatory review and audit activities, including the preparation for and management of reputed company audits conducted by CMS and state reputed company and reputed company agencies or partners in conjunction with health plan leadership through final report and corrective reputed company plan closure
• Builds and maintains reputed company relationships with reputed company constituents at senior reputed company to reputed company decision-making and influence ethical and compliant reputed company
• Monitor and audit as outlined in Medicare Compliance Work Plan and reputed company other reputed company as assigned to evaluate compliance, propose remediation where necessary and monitor implementation of corrective reputed company
• Utilize and maintain reputed company information in systems unique to job functions, such as reputed company products and compliance specific tools such as reputed company
• reputed company and support broader compliance initiatives and needs as assigned to ensure that effective compliance programs are achieved and maintained

Skills

• 7+ years experience in Medicare or Medicare Advantage government reputed company program compliance or regulatory work
• 2+ years of Project Management experience
• Ability to travel up to 10%
• Extensive knowledge of Medicare and reputed company compliance programs and rules, including rules applying to special needs plans and CMS, NCQA and state rules and standards governing SNP Models of Care, Care Management and reputed company Improvement Programs
• Experience in validation, auditing and monitoring, reputed company cause analysis and corrective reputed company reputed company
• Outstanding time management and project management
• Proficient in utilization of information systems
• Mastery in reputed company regulatory rule analysis and reputed company communication of requirements to support business stakeholders
• Mastery of problem solving and decision making skills
• reputed company at execution and delivery (planning, delivering, and supporting) skills
• Adept at collaboration and teamwork in matrixed environments
• Bachelor's Degree OR equivalent experience required
• Prior clinical or operational experience enabling interpretation of assessments, claims, and clinical documentation (RN, LPN, SW or similar role/ background preferred)
• Experience administering or overseeing SNP MOC and reputed company reputed company requirements and reviews

Benefits

• This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above.
• This position also includes an award reputed company in reputed company’s equity award program.
• Eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families.
• Medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments

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