Compliance Manager - Health Plan/CMS (Remote)

Confidential; United States; Remote; USD 70,000 - 198,000; Full time

Job summary

A leading company in the health insurance sector is seeking a Compliance Manager with expertise in regulatory compliance and strong managerial skills. The ideal candidate will evaluate compliance regulations, educate stakeholders, and ensure adherence to industry standards in a remote environment.

Qualifications

• Five years’ experience at a health plan, with proven Managed Care experience.
• Strong knowledge of CMS/Health Plan processes and regulations is required.
• Proven Management experience in a compliance role with regulatory reporting experience.

Responsibilities

• Evaluate and implement compliance regulations and monitor internal programs.
• Educate leadership and staff on regulatory changes and compliance requirements.
• Facilitate internal audits and assist clients with CMS audit preparations.

Skills

Analytical mindset

Interpersonal abilities

Outstanding communication

Organizational skills

Education

Bachelor’s Degree

Tools

Microsoft applications

Job description

Compliance Manager - Health Plan/CMS (Remote)

Compliance Manager - Health Plan/CMS (Remote)

Get AI-powered advice on this job and more exclusive features.

This position will perform a range of duties including, but not limited to, evaluating all current and new compliance regulations, reviewing company policies and procedures, provide subject matter expertise and performing internal audits. The successful candidate will be able to multi-task and be an excellent communicator, with in-depth knowledge of the latest industry trends and regulations.

Responsibilities:

• Keep abreast of regulatory developments within or outside of the company as well as evolving regulatory landscapes and best practices in compliance programs
• Ensure our product solution is compliant with applicable requirements (i.e. Medicare, NCQA) by notifying internal teams of regulatory changes and working with them to develop requirements for enhancements
• Educate and communicate verbally and in writing to leadership, impacted staff and current/new clients on any new or changes to regulations
• Facilitate internal audits as well as perform mock audits using CMS audit and Corrective Action Plan (CAP) protocols
• Assist clients with CMS audit preparation, as well as provide action oriented detailed feedback
• Ability to work with new clients during implementation to ensure no compliance issues are identified
• Ensure product content, workflow and SLAs meet client, regulatory and accreditation requirements
• Conduct platform testing as part of the software development life cycle to ensure compliance prior to release
• Identify key stakeholders and assist in RCA process to ensure RCAs are completed and delivered timely
• Ensure any corrective action plans are issued and tracked to completion
• Able to adapt to competing demands, take on new responsibilities, and adjust schedule to meet changing priorities
• Monitor internal compliance programs on an ongoing basis and ensure modules are compliant with the most current regulatory body requirements, keeping privacy practices in place and remaining fully compliant.
• Update client monthly steering decks with all applicable changes and notifications for the month, verbally communicate these changes in client meetings

Requirements:

• Five years’ experience at a health plan, with proven Managed Care experience
• Proven Management experience in a compliance role with regulatory reporting experience
• Strong knowledge of CMS/Health Plan processes and regulations is required
• Experience with regulatory reporting, ODAG, CDAG, and NCQA
• Outstanding communication and interpersonal abilities
• An analytical mindset with exceptional organizational skills
• Firsthand experience with health plan operation sin utilization management, appeals, grievances, pharmacy and or case management
• Methodical and diligent with outstanding planning abilities
• An analytical mind able to “see” the complexities of procedures and regulations
• Experience researching and summarizing applicable regulatory requirements
• Ability to write updates and memos to C-suite level internal and external clients
• Superb written, verbal communication and interpersonal skills
• Excellent in the use of Microsoft applications

Education Requirement:

Bachelor’s Degree - Associates Degree or relevant work experience

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Administrative, Consulting, and Health Care Provider

• Industries

  Insurance and IT System Custom Software Development

Referrals increase your chances of interviewing at Confidential by 2x

Sign in to set job alerts for “Compliance Manager” roles.

Regulatory and Licensing Compliance Manager

United States $112,000.00-$179,000.00 5 days ago

United States $110,500.00-$130,000.00 2 weeks ago

United States $70,000.00-$75,000.00 1 day ago

United States $72,417.00-$108,522.00 3 weeks ago

United States $150,000.00-$175,000.00 4 days ago

Compliance Manager, Regulatory Change Management

United States $105,600.00-$198,000.00 1 week ago

Mountain View, CA $210,000.00-$250,000.00 2 months ago

United States $110,000.00-$140,000.00 5 days ago

United States $146,200.00-$233,900.00 2 weeks ago

United States $85,000.00-$95,000.00 2 days ago

United States $84,000.00-$118,000.00 22 hours ago

Vice President, Compliance and Legal Affairs

New York, United States $160,000.00-$250,000.00 2 weeks ago

Regulatory Compliance and Contracts Administrator (Remote - US)

Compliance Manager - Invest - (Remote - US)

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.