Medicare Compliance & CTM Lead

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 114,000 - 211,000; Full time

Job summary

CareFirst BlueCross BlueShield in Baltimore, MD seeks a compliance leader to establish and monitor government program processes, focusing on CTM, vendor oversight, and regulatory compliance. You will work with Leadership, Legal, Mandates, and delegated entities to ensure CMS requirements and federal/state regulations are met.

Responsibilities include managing risk-based monitoring, audit readiness, and producing reports for leadership; mentoring staff; and driving improvements to enhance member

Qualifications

• Education level required: Bachelor's Degree in Healthcare Compliance, Risk Management, Business Administration or related field.
• Experience: 5 years in health insurance, managed care, or government programs with CTM or regulatory oversight.
• Supervisory experience of at least 1 year.

Responsibilities

• Leads end-to-end CTM process management for timely complaint handling and escalation.
• Oversees vendor management compliance across Medicaid-related entities and delegated entities.
• Interprets regulations and CMS expectations to keep policies and SOPs compliant.
• Develops risk-based monitoring, audits, and corrective actions.
• Prepares CTM and risk reports for leadership and committees.
• Leads performance, training, and development for CTM and compliance staff.

Skills

Leadership

Regulatory interpretation

CMS Medicare MA

Audit readiness

Cross-functional collaboration

Education

Bachelor's Degree in Healthcare Compliance, Risk Management, Business Administration or related field

Job description

CareFirst BlueCross BlueShield in Baltimore, MD seeks a compliance leader to establish and monitor government program processes, focusing on CTM, vendor oversight, and regulatory compliance. You will work with Leadership, Legal, Mandates, and delegated entities to ensure CMS requirements and federal/state regulations are met.

Responsibilities include managing risk-based monitoring, audit readiness, and producing reports for leadership; mentoring staff; and driving improvements to enhance member