Remote Regulatory Compliance Program Manager – UM

CommonSpirit Health; Bakersfield (CA); Remote; USD 59.000 - 88.000; Vollzeit

Zusammenfassung

CommonSpirit Health seeks a Program Manager UM Regulatory Compliance to oversee delegated audits across UM, Credentialing, Claims, Enrollment, and Appeals, aligning with payers and regulatory bodies. You will educate staff, update policies and workflows, and document procedures to ensure compliant operations.

As a remote employee, you will work PST business hours and collaborate with DHMSO Compliance, local leadership, and vendor contracts to close gaps and drive action plans.

Qualifikationen

• Five (5) years experience participating in audits, reviewing and documenting policies and procedures.
• Bachelor's degree.
• Experience in reviewing and interpreting regulatory requirements.
• Knowledge of Knox-Keene, DMHC and CMS rules for claims, eligibility and appeals.
• Guide teams to implement appropriate process changes.
• Collaborate with leaders to assess operational impact and present to management.

Aufgaben

• Subject matter expert on state and national regulatory bodies.
• Oversee local audits to ensure ongoing regulatory compliance and develop action plans.
• Maintain operational policies and program descriptions aligned with updates.
• Collaborate with staff education for annual regulatory training.
• Assist leadership with audits and contract delegation activities.

Kenntnisse

Auditing

Policy documentation

Regulatory interpretation

Stakeholder communication

Change management

Cross-functional collaboration

Ausbildung

Bachelor's degree

Tools

Lucidchart

Microsoft Visio

Google Workspace

Microsoft Office

Jobbeschreibung

CommonSpirit Health seeks a Program Manager UM Regulatory Compliance to oversee delegated audits across UM, Credentialing, Claims, Enrollment, and Appeals, aligning with payers and regulatory bodies. You will educate staff, update policies and workflows, and document procedures to ensure compliant operations.

As a remote employee, you will work PST business hours and collaborate with DHMSO Compliance, local leadership, and vendor contracts to close gaps and drive action plans.