Senior Health Plan Compliance Manager

Presbyterian Healthcare Services; Albuquerque (NM); On-site; USD 81,000 - 139,000; Full time

Benefits offered by this job

Comprehensive benefits package

Wellness program

Job summary

Presbyterian Healthcare Services is hiring a Compliance Manager in Albuquerque, NM. The role supports the Compliance Officer in implementing the health plan compliance program, monitoring audits, and coordinating responses to regulatory bodies.

You will work with staff across departments to ensure adherence to state and federal laws, and help drive risk mitigation and training programs. The position is full-time, with responsibilities including governance, risk assessments, and collaboration

Qualifications

• Five to seven years experience in healthcare management or law/regulations.
• Managed care health plan experience in Medicare, Medicaid or Commercial required.
• CHC or willing to obtain within 1 year.

Responsibilities

• Assists with ensuring that PHP has written compliance standards and procedures covering all necessary areas to be followed by PHP employees and other agents.
• Provides direction and oversight of all compliance program auditing, monitoring and related functions, including Risk Assessments and meeting contractual obligations.
• Consults with operational departments and program/subject matter experts to recommend compliant solutions that support business goals.
• Proactively identifies compliance issues and works with the Compliance Officer to mitigate risks.
• Assists with the implementation and management of compliance training.
• Oversees monitoring and auditing procedures to determine compliance with PHP standards and procedures.
• Supports investigations of alleged violations of standards and procedures.
• Reports potential fraud and noncompliance to the Compliance Officer and leadership.
• Interacts with directors and managers regarding compliance issues.
• Organizes cross-functional teams to address issues involving multiple departments.

Education

Bachelor's Degree

Job description

Presbyterian Healthcare Services is hiring a Compliance Manager in Albuquerque, NM. The role supports the Compliance Officer in implementing the health plan compliance program, monitoring audits, and coordinating responses to regulatory bodies.

You will work with staff across departments to ensure adherence to state and federal laws, and help drive risk mitigation and training programs. The position is full-time, with responsibilities including governance, risk assessments, and collaboration