Job Summary:
The Senior Manager, Compliance provides compliance oversight, organizational leadership related to compliance, ensures the department proactively collaborates with partners, provides insights from analyses being conducted and leads a team that develops and maintains comprehensive State and Federal Regulatory Guidebooks, job aids, and other tools and resources needed to support wide-spread compliance in delegated and non-delegated Marketplace (Qualified Health Plan), Medicare and Medicaid services as applicable to the Senior Manager’s specific product oversight. Strong health plan/MCO compliance and AI experience preferred.
Essential Functions:
- Serve as a compliance leader in the Marketplace, Medicare and Medicaid arena as applicable
- Manage the Federal and State regulator relationships including but not limited to the Center for Consumer Information and Insurance Oversight (CCIIO) and Centers for Medicare & Medicaid Services (CMS) Federal account managers, Department of Insurance (DOI) State regulators and State Medicaid regulators (collectively “regulators”) and oversee the development, execution, and follow-up for regulator meeting agendas
- Oversee all Marketplace, Medicare and Medicaid compliance activities performed and tracked by compliance staff including, but not limited to, internal business owner and external regulator inquiry management, State complaint management, regulatory distribution management, and compliance workplan execution
- Lead and organize Marketplace, Medicare and Medicaid Compliance Committees and workgroups as applicable, representing both State and Federal updates across all markets
- Oversee Marketplace, Medicare and Medicaid policies and procedures (P&P) and standard operating procedures (SOP) to ensure compliance with Federal and State regulatory, statutory, corporate, and contractual standards and obligations
- Remain current in Federal/State laws and regulations regarding Marketplace, Medicare and Medicaid requirements as well as general compliance and delegation oversight best practices and industry standards
- Provide feedback to Compliance leadership concerning key risks in Marketplace, Medicare and Medicaid so that Compliance leadership may complete the annual compliance risk assessment
- Assist with the execution of the compliance work plan
- Respond to compliance incidents and ensure appropriate reporting and communication with business leaders and compliance team members
- Provide feedback and recommendations for ongoing monitoring or improvement to the Compliance Corrective Action Team regarding corrective action plans
- Oversee and ensure that all Marketplace, Medicare and Medicaid compliance activity tracking is developed, maintained and reported to internal and external stakeholders
- Assist with regulatory audits and support audit readiness activity
- Assist with oversight of data validation of all internal and external compliance and regulatory reporting
- Act as a resource for internal departments to assist with external-entity related escalated issues
- Identify compliance knowledge gaps and collaborates with applicable business teams to develop training programs to address the gaps
- Provide compliance training for all internal and external stakeholders to ensure compliance program effectiveness
- Cultivate effective relationships, collaborate with, and provide Marketplace, Medicare and Medicaid compliance expertise including both State and Federal requirements to Market leadership, and other Corporate leadership and business departments to ensure effective compliance program management
- Establish and maintain positive working relationships with State and Federal regulators ensuring to build goodwill and trust for CareSource as an entity
- Provide subject matter expertise in support of Marketplace, Medicare and Medicaid market and enterprise initiatives
- Ensure direct line leadership and the applicable Marketplace, Medicare and Medicaid business Leadership are informed of all material regulatory initiatives, compliance concerns, operational issues and associated corrective actions and corresponding remediations impacting CareSource
- Develop, recruit, retain, and manage compliance staff to ensure that Marketplace, Medicare and Medicaid operational and strategic goals are met while maintaining compliance with company, State, Federal and contractual requirements for all lines of business
- Supervise staff for successful execution of assigned duties, performance management feedback, and disciplinary issues
- Train current and new staff members on departmental policies and procedures; develops staff training materials when necessary
- Proactively keep the management team apprised of the team’s performance, projects and issues
- Perform any other job duties as requested
Education and Experience:
- 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
Competencies, Knowledge and Skills:
- Ability to develop and foster effective collaborative relationships with market and enterprise management in a matrix environment
- Strong conflict resolution, negotiating and influencing skills
- 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
- Leadership ability with a high level of professionalism
- 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
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- Required to travel to market office(s) on occasion
Compensation Range:
$94,100.00 - $164,800.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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