Medicare Regulatory Oversight Manager

Provider Partners Health Plan; Watson Lake; Remote; CAD 80,000 - 100,000; Full time

Job summary

A leading healthcare plan provider seeks a Medicare Regulatory Oversight Manager to ensure compliance with Medicare regulations. The role requires strong analytical and communication skills, alongside significant experience in managed care compliance. You will collaborate with management to dissect regulatory changes and guide operational adjustments to uphold standards. Ideal candidates will have a bachelor's degree and be CHC certified, with a robust background in healthcare compliance.

Qualifications

• 5+ years experience in federal regulations compliance.
• Knowledge of CMS Medicare Part C and D requirements.
• Excellent writing and synthesizing complex information.

Responsibilities

• Monitor regulatory compliance activities and implement strategies.
• Analyze CMS regulations and their impact on business.
• Serve as subject matter expert on compliance and industry trends.

Skills

Regulatory Compliance

Analytical Skills

Communication Skills

Project Management

Critical Thinking

Interpersonal Skills

Education

Bachelor’s degree

Certified in Healthcare Compliance (CHC)

Project Management Professional (PMP)

Tools

Microsoft Office Products

Job description

Location: Remote

Job Id:449

# of Openings:1

The Provider Partners Health Plans (Provider Partners) Medicare Regulatory Oversight Manager reports
to the Compliance Director and will support the Compliance Director and Chief Compliance Officer (CCO)
in the oversight and management of corporate compliance activities to help ensure Provider Partners
complies with CMS Medicare Advantage (Part C) and Medicare Prescription Drug (Part D) Program
regulations and guidelines, applicable federal and state laws, and Company policies and procedures.
Responsibilities include, but are not limited to, creating a culture of regulatory readiness through
continual proactive measures, translating complex regulatory requirements into practical business
guidelines, overseeing the integration of newly enacted requirements into operations, ensuring business
owners understand and comply with new and/or revised regulations and requirements, identifying
potential non-compliance vulnerabilities, and making practical business recommendations to correct non-
compliance or improve insufficient processes.
PRINCIPAL ACCOUNTABILITIES
•
Proactive identification and analysis of CMS proposed rules, final rules, new and/or updated guidance
documents relevant to Medicare Parts C and D Programs, including the Annual Readiness Checklist,
to determine potential impacts on organizational processes.
•
Disseminate plain language compliance guidance that interprets and summarizes a broad array of
proposed, newly enacted, revised or pending Medicare regulations/program requirements that affect
multiple business teams; collaborate, and advise business teams on regulatory interpretations,
changes to previous regulations, and provide direction to assist business teams in operationalizing
new and/or changed regulatory requirements.
•
Develop and implement regulatory auditing and monitoring strategies and tools to help oversee the
action plans and quality controls established and undertaken by the business teams to achieve
compliance with newly enacted and pending program regulations; assess business action plans and
outcomes to ensure timeliness, accuracy, comprehensiveness, and adherence/conformity to
regulatory standards.
•
Establish, maintain knowledge, and serve as a subject matter expert on legislative changes and
emerging trends regarding industry regulations.
•
Support and actively participate in compliance team functions including, but not limited to,
compliance risk assessments, review and development of compliance policies & procedures,
compliance auditing and monitoring work plan development, ongoing auditing and monitoring
activities, Compliance Committee reporting, external audit readiness, external audit support, etc.
•
Proactively identify areas of improvement for the Compliance Department and participate in
development of performance improvement initiatives.
•
Under the direction of the Compliance Director, assist in preparing the Plan for regulatory audits.
•
Meet regularly with the Compliance Director to set priorities, ensure work efforts are aligned, and
discuss identified issues and opportunity improvement.
•
Successful and timely completion of assigned duties/projects.

QUALIFICATIONS
• 5+ years of experience in the interpretation and application of federal regulations, policies and procedures, and ethical principles and practices of managed care.
• Bachelor’s degree from an accredited university, 7+ years of relevant work experience can be utilized in lieu of a bachelor’s degree, a higher degree cannot be substituted for work experience.
• Knowledge and experience with CMS Medicare Part C and Part D regulatory requirements.
• Broad-based in-depth knowledge of the managed care industry, including strategic compliance planning, regulatory concerns, compliance requirements and corporate integrity principles.
• Working knowledge of Medicare Managed Care plan business functions (e.g., utilization management, appeals, grievances, call center management, claims processing, enrollment, provider network management, credentialing, etc.)
• Proficient writing expertise, ability to write effectively and succinctly, convey information clearly and concisely without ambiguity and in a logical coherent flow that guides the reader through the text; writing must not require extensive re-writes/editing by the Compliance Director.
• Critical thinking skills and the ability to apply analytical approach to regulatory research, identify potential noncompliance issues, obtain information to clarify and describe issue, and exercise sound-decision-making (problem solving acumen).
• Persuasion/negotiation and interpersonal relationship skills, the ability to effectively interact with and present highly complex information to and respond to questions from senior management.
• Certified in Healthcare Compliance (CHC) or able to obtain within 3 years of hire.
• Previous experience in entity accreditation reviews is preferred but is not required.
• Project Management Professional (PMP) certification is preferred but is not required.
PROFESSIONAL COMPETENCIES
• Proficiency in Microsoft Office Products (specifically Excel and PowerPoint)
• Proficient communication skills and the ability to synthesize complex information and act upon as necessary.
• Excellent organizational skills, ability to manage competing projects and meet tight deadlines.
• Skilled at managing a high volume of work with changing priorities and frequent interruptions while maintaining the ability to work cooperatively with a positive attitude.
• Active listening, facilitation, and presentation skills.
• High degree of discretion in dealing with the confidentiality of all compliance-related matters.