Remote UM Regulatory Compliance Program Manager

CommonSpirit Health; Bakersfield (CA); Remote; USD 110,000 - 160,000; Full time

Job summary

Dignity Health Management Services is seeking a Program Manager UM Regulatory Compliance to oversee audits and ensure alignment with payer contracts across DHMSO operations.

You will educate staff, update policies, and document workflows to maintain ongoing regulatory compliance, partnering with operational leaders and payers.

The role is remote with equipment provided and requires working PST business hours.

Qualifications

• Five years of audit experience with policy documentation.
• Bachelor’s degree required.
• Experience interpreting Knox-Keene, DMHC and CMS rules for various lines.
• Ability to guide staff and coordinate cross-functional teams.
• Experience creating workflow documents and DLPs is a plus.

Responsibilities

• Oversee delegated audits for UM, Credentialing, Claims, Enrollment, and Appeals.
• Educate staff and update policies and workflows to maintain compliance.
• Act as liaison between payers and local market leadership.
• Operationalize regulatory communications and update procedures.
• Develop action plans to close gaps and monitor audit results.
• Assist in contract delegation and cross-functional coordination.

Skills

Audit oversight

Regulatory compliance

Process improvement

Stakeholder collaboration

Change management

Policy documentation

Education

Bachelor's degree

Job description

Dignity Health Management Services is seeking a Program Manager UM Regulatory Compliance to oversee audits and ensure alignment with payer contracts across DHMSO operations.

You will educate staff, update policies, and document workflows to maintain ongoing regulatory compliance, partnering with operational leaders and payers.

The role is remote with equipment provided and requires working PST business hours.