SNP Operations & Compliance Manager

Devoted Health Services, Inc; Waltham (MA); Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Health, dental and vision coverage

Generous paid time off

Stock options for all employees

Bonus eligibility for all roles

Job summary

Devoted Health is seeking a Regulatory Compliance professional to lead SNP operations, translating CMS and Medicaid requirements into seamless workflows. You will oversee policies, build early warning systems, and support frontline teams in delivering compliant Medicare and Medicaid services.

You will collaborate with cross-functional teams, manage Model of Care processes, and ensure audit readiness across SNP programs. Remote work is available in the US.

Qualifications

• 3+ years of experience in Medicare Advantage, Managed Care, Health Plan, or health care operations.
• Ability to interpret CMS and/or State Medicaid regulatory guidelines and translate them into standard operational workflows and compliance processes.
• Highly detail-oriented, reliable, independent, and curious, with a track record of managing detailed compliance tasks in a fast-paced environment.
• Strong communication skills with a demonstrated ability to collaborate with and influence cross-functional teams.

Responsibilities

• Develop Devoted's Models of Care (MOCs) annually in collaboration with the SNP Operations Director.
• Oversee and manage Devoted's policies, procedures, and compliance universes in compliance with CMS and Model of Care requirements, ensuring perpetual audit-readiness.
• Review new or changing Model of Care and CMS requirements, working cross-functionally to develop and implement operational solutions.
• Develop and implement enhanced processes to oversee compliance with Model of Care and CMS-related SNP requirements, including building early warning systems to detect and prevent potential gaps.
• Develop Medicaid benefit subject matter expertise, creating knowledge tools and configurations that support frontline staff and members in understanding and coordinating Medicare and Medicaid benefits.
• Oversee, with the SNP Operations Director and other SNP Managers, routine Medicaid reporting, and work cross-functionally to develop and submit required Medicaid reports accurately and timely.
• Provide additional compliance and operational support across SNP and Medicaid programs as assigned.

Skills

Medicare Advantage

Managed Care

Healthcare operations

CMS/Medicaid regulations

Cross-functional collaboration

Job description

Devoted Health is seeking a Regulatory Compliance professional to lead SNP operations, translating CMS and Medicaid requirements into seamless workflows. You will oversee policies, build early warning systems, and support frontline teams in delivering compliant Medicare and Medicaid services.

You will collaborate with cross-functional teams, manage Model of Care processes, and ensure audit readiness across SNP programs. Remote work is available in the US.