Sr. Utilization Management Compliance Analyst

Liberty Dental Plan; Tustin (CA); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare compliance is seeking a Sr. Utilization Management Compliance Analyst. This role involves ensuring adherence to CMS and State requirements, leading audits, and collaborating with teams on compliance initiatives. Ideal candidates will have a strong background in healthcare compliance and excellent analytical skills.

Benefits

401(k) retirement benefits

Affordable medical insurance

100% employer-paid dental coverage

Flexible Spending Accounts

Generous vacation and sick leave policies

Tuition reimbursement

Employee Assistance Program (EAP)

Qualifications

• Minimum of 4 years of experience in utilization management or healthcare compliance.
• Strong knowledge of CMS regulations and policies.

Responsibilities

• Lead client and external audits for Utilization Management Operations.
• Collaborate with teams to review and update policies and procedures.
• Monitor compliance issues related to CMS and State regulations.

Skills

Analytical Skills

Communication

Organizational Skills

Education

Bachelor’s degree in Healthcare Administration

Tools

Microsoft Office

Job description

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Job Summary

Are you a champion for healthcare compliance and regulatory excellence? As a Sr. Utilization Management Compliance Analyst, you'll play a vital role in ensuring our Utilization Management (UM) program meets CMS and State requirements. Lead audit preparation, drive key compliance initiatives, and empower teams to uphold the highest standards in patient care.

Position is preferred in Central or Eastern Time Zones.

What You'll Do

• Lead client and external audits for Utilization Management (UM) Operations, including managing all UM audits, corrective action activities, and reporting on findings and outcomes.
• Respond to UM Corrective Action Plans (CAPs) by identifying root causes, developing remediation plans, implementing compliance controls, and monitoring outcomes.
• Collaborate with the Liberty Compliance Department and cross-functional teams to review and update policies, procedures, and operational practices.
• Provide compliance training and guidance to staff on regulatory requirements and best practices.
• Research and resolve compliance issues related to CMS and State regulations, ensuring prompt and effective resolution.
• Report on UM performance metrics and compliance activities in Committee meetings, including UM Quality Committees.
• Work with Account Management, System Configuration, and other departments to review UM letter templates for regulatory, clinical, and operational accuracy.
• Prepare and assist in the submission of compliance reports to clients and the Compliance Department as needed.
• Monitor and stay informed of changes to CMS regulations and ensure timely implementation of updates within UM operations.
• Serve as a key support contact for compliance-related inquiries and issues within UM.
• Draft and review responses to CAPs and audit findings, ensuring clarity, accuracy, and timeliness.
• Support research and analysis of regulatory requirements, legislative changes, and organizational initiatives to assess their impact on UM operations.
• Take a lead role in developing, maintaining, and publishing internal and external policies and procedures.
• Communicate effectively with internal and external stakeholders to ensure alignment, manage expectations, and meet critical deadlines.

What You'll Bring

• Bachelor’s degree in Healthcare Administration, Public Health, Business Administration, or a related field; or an equivalent combination of education and relevant work experience.
• A minimum of 4 years of experience in utilization management or healthcare compliance, with a focus on CMS Medicaid and Medicare guidelines.
• Strong knowledge of CMS regulations, policies, and reporting requirements related to Medicare and Medicaid programs.
• Proficiency with Microsoft Office tools, including Outlook, Excel, Word, SharePoint, and PowerPoint.
• Excellent analytical skills and attention to detail, with the ability to interpret complex regulations and guidelines.
• Strong organizational and prioritization skills to manage multiple tasks and meet deadlines.
• Effective communication and interpersonal skills, with a collaborative mindset and the ability to work well in a team environment.
• Familiarity with compliance programs and auditing processes (preferred).
• Knowledge of HSP or Meditrac systems (preferred).

Location

Position is highly preferred in central or eastern time zone. Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

What Liberty Offers

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

• Competitive pay structure and savings options to help you reach your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
• 100% employer-paid dental coverage for employees and eligible dependents.
• Vision insurance with low-cost premiums for employee-only coverage and dependents.
• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
• Flexible Spending Accounts for healthcare and dependent care expenses.
• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
• Long-term disability coverage.
• Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
• Employee Assistance Program (EAP) to support mental health and well-being.
• Generous vacation and sick leave policies, with the ability to roll over unused time.
• 10 paid company holidays.
• Tuition reimbursement for eligible educational expenses.
• Remote or hybrid work options available for various positions.

Compensation

In the spirit of pay transparency, the base salary range for this position is $70,000 - $90,000, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Sponsorship and Relocation Specifications

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.