Remote UM Regulatory Compliance Program Manager

Dignity Health Management Services; United States; Remote; USD 85,000 - 110,000; Full time

Job summary

Dignity Health Management Services is seeking a Program Manager UM Regulatory Compliance to oversee delegated audits across UM, Credentialing, Claims, Enrollment, and Appeals. You will coordinate with Compliance to ensure contractual obligations with payers are met, educate staff, and streamline policies and workflows.

As a remote employee, you will partner with multiple departments, manage payer audits, and drive action plans to close gaps while aligning with regulatory updates and vendor

Qualifications

• Five (5) years experience participating in audits, reviewing and documenting policies and procedures.
• Bachelor's degree.
• Experience in reviewing and interpreting regulatory requirements.
• Working knowledge of Knox-Keene, DMHC and CMS rules for Claim Submission, Claim Payment, Eligibility, Appeals for Commercial, Medicare and Medicaid lines of business.
• Guidance and working with others to determine and recommend appropriate process change or process implementation.
• Proven ability to work with other business functions to determine operational impact, recommend best practice and articulate to leadership.

Responsibilities

• Oversee delegated audits related to UM, Credentialing, Claims, Enrollment, and Appeals.
• Educate staff, update policies and workflows to maintain compliance.
• Act as liaison between payers and market leadership; manage payer audits and corrective action plans.
• Operationalize regulatory communications (APL/CMS memos) with upstream and downstream teams.
• Develop and communicate process changes; guide staff in change management.

Skills

Auditing

Policy documentation

Regulatory compliance

CMS rules understanding

Cross-functional collaboration

Education

Bachelor's degree

Tools

Lucidchart

Microsoft Visio

Google Workspace

Job description

Dignity Health Management Services is seeking a Program Manager UM Regulatory Compliance to oversee delegated audits across UM, Credentialing, Claims, Enrollment, and Appeals. You will coordinate with Compliance to ensure contractual obligations with payers are met, educate staff, and streamline policies and workflows.

As a remote employee, you will partner with multiple departments, manage payer audits, and drive action plans to close gaps while aligning with regulatory updates and vendor