Compliance Program Manager (Clinical Audit & Oversight)

Health Plan of San Joaquin/Mountain Valley Health Plan; French Camp (CA); Remote; USD 109,000 - 160,000; Full time

Job summary

An established industry player is seeking a Compliance Program Manager to lead clinical operations and ensure adherence to regulatory standards. This remote role requires a deep understanding of managed care processes and a strong ability to manage projects effectively. The ideal candidate will oversee compliance activities, monitor performance metrics, and develop corrective action plans. With a competitive salary and a comprehensive benefits package, this position offers a unique opportunity to make a significant impact in the healthcare sector while working from the comfort of your home in California.

Benefits

PTO

Health insurance

Dental insurance

Vision insurance

Retirement plans

Wellness programs

Qualifications

• Deep knowledge of managed care oversight processes and regulatory standards.
• Experience with Medi-Cal and Medicare D-SNP programs.

Responsibilities

• Serve as the primary contact for internal departments regarding compliance.
• Conduct audits to ensure compliance with state and federal standards.

Skills

Managed care oversight processes

Regulatory standards

Project management

Communication skills

Leadership skills

Education

Associate’s degree with RN or LVN license

Bachelor’s degree in healthcare project management

Tools

MS Office

Power BI

SharePoint

Job description

Compliance Program Manager (Clinical Audit & Oversight)

Join us as a Compliance Program Manager (Clinical Audit & Oversight) at Health Plan of San Joaquin/Mountain Valley Health Plan.

We are hiring a Compliance Program Manager to oversee clinical operations and ensure regulatory compliance. This is a remote position requiring residence in California.

Pay Range

Base pay ranges from $109,590 to $159,900 annually, depending on experience and qualifications. Talk to your recruiter for more details.

Responsibilities

• Serve as the primary contact for internal departments and third-party entities regarding contractual and regulatory obligations.
• Monitor and track performance metrics for clinical departments and vendors.
• Conduct readiness assessments and audits to ensure compliance with state, federal, and NCQA standards.
• Oversee clinical operational areas such as Utilization Management, Case Management, Behavioral Health, and Quality Improvement.
• Communicate oversight results and escalate risks or issues as needed.
• Develop and oversee corrective action plans for non-compliance.
• Provide training and collaborate in joint operations meetings.
• Support team members to ensure continuity of compliance activities.

Qualifications

• Deep knowledge of managed care oversight processes and regulatory standards.
• Experience with Medi-Cal and Medicare D-SNP programs.
• Strong project management, communication, and leadership skills.
• Proficiency in MS Office, Power BI, and SharePoint.
• Valid California RN, LVN license, or equivalent clinical licensure.

Preferred Skills

• Experience with Medi-Cal and Medicare managed care operations.
• Knowledge of CMS and state regulatory requirements.

Education & Experience

• Associate’s degree with RN or LVN license and 4+ years of healthcare project management experience, or
• Bachelor’s degree with 2+ years in healthcare project management, or an equivalent combination.

Benefits

• Competitive salary and comprehensive benefits package.
• PTO, holidays, and retirement plans.
• Health, dental, vision, and wellness programs.

Equal Opportunity

We are committed to diversity and equal employment opportunities for all applicants and employees.