Medicare Compliance Manager (Medicare Advantage Required) - REMOTE

Molina Healthcare; Scottsdale (AZ); Remote; USD 77,000 - 156,000; Full time

Job summary

A leading healthcare provider in Scottsdale, AZ is seeking a Compliance Manager to establish and oversee compliance programs ensuring adherence to relevant laws and regulations. The ideal candidate has 5-7 years of experience, preferably in the healthcare sector, and is skilled in developing compliance policies and managing audits. This role offers a competitive salary range of $77,969 - $155,508 annually, with benefits included.

Qualifications

• 5-7 years of compliance-related experience in the healthcare field.
• Preferred 7-9 years of experience in a health plan setting.
• Strong analytical and problem-solving skills.

Responsibilities

• Monitor and ensure compliance with laws and regulations.
• Lead development and implementation of compliance protocols.
• Conduct regulatory audits and manage corrective action plans.
• Facilitate training programs for compliance across the enterprise.

Skills

Implementation of Compliance Programs

Development of Compliance Policies

Regulatory Audits Management

Investigation and Resolution Skills

Industry Compliance Trends Awareness

Education

Bachelor's Degree

Master's Degree (Preferred)

Job description

Job Description

Job Summary

Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

Knowledge/Skills/Abilities

• Assists with implementation and day-to-day operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud, Waste and Abuse Plan across the enterprise while ensuring compliance with governmental requirements.

• Spearheads development and implementation of compliance policies and procedures and training programs for the Molina enterprise.

• Oversees and provides direction of site visits for regulatory audits and coordinates corrective action plan, as needed.

• Investigates and resolves compliance problems, questions, or complaints received internally or from customers/agencies.

• Provides input and representation on key compliance initiatives, meetings, and committees. Stays abreast of industry and compliance trends; recommends and implements changes to internal company processes as needed..

Job Qualifications

Required Education

Bachelor's Degree or equivalent combination of education and experience

Required Experience

5-7 years

Preferred Education

Masters Degree preferred; will consider previous experience in health plan setting in government programs management (Contract Manager)

Preferred Experience

7-9 years

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $155,508 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.