Compliance Manager - Louisiana

Magellan Health • Baton Rouge, LA

1d • Remote

About The Position

This position serves as the compliance and privacy manager for assigned areas of the company or an SBU as applicable. It assists with regulatory and contract compliance for business managed by the Care Center or supported by corporate compliance. The role is responsible for the implementation of or support of the SBU and/or Corporate Compliance Program, Health Insurance Portability and Accountability Act (HIPAA) compliance, including audits and the preparation for state and customer audits. If applicable, the manager oversees the implementation and ongoing operation of the Compliance Program for the assigned SBU(s). If applicable, the manager develops and annually updates a formal written compliance program for the assigned Care Management Center and educates staff about compliance and the appropriate details of the compliance program. The role directs federal and state regulatory and compliance activities. It customizes corporate policies where necessary to address state regulatory standards and/or contractual requirements and, where applicable, works with corporate compliance on any customizations that are required due to state regulatory standards. The manager serves as a liaison for customers on legal and regulatory issues. If applicable, the manager chairs the local compliance committee meetings. The role coordinates activities with the Internal Audit and Special Investigations Unit (SIU) on compliance matters including fraud, waste, and abuse auditing and monitoring, as directed. Ensures corrective actions are implemented for all known compliance deficiencies. Submits reports to the Quality Improvement Committee (QIC), Compliance Committee, Business Unit Manager, and the corporate Compliance Department as appropriate. Maintains expertise related to authorization and non-authorization correspondence requirements from the perspective of the Employee Retirement Income Security Act of 1974 (ERISA), National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), federal regulations and state law. Assists in review of standard correspondence, notifying policy content experts of changes to standard policies, and working with IT regarding system changes as it relates to correspondence. If applicable, attends customer meetings to report on compliance matters. Serves as central contact for internal and external customers regarding certain parts of the corporate compliance program as assigned or, where applicable, security, HIPAA, and anti-fraud efforts within the assigned Care Center. Assists with internal and external audits and reporting, including periodic reports documenting compliance status. If applicable, oversees Care Center-delegated entities and their compliance activities and assures that compliance data from the delegated entities are reported to the Quality Improvement Committee (QIC). The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Requirements

• Knowledge of HIPAA, federal and state regulatory processes.
• Strong interpersonal, organizational, and project management skills.
• Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
• Excellent verbal and written communication skills.
• 5-8 years compliance related experience.
• Experience and thorough understanding of Microsoft Office, flow charting and other relevant software systems and applications.
• Candidates must reside in Louisiana.
• A Combination of Education and Work Experience May Be Considered.

Nice To Haves

• Medicare Advantage and/or Medicaid managed care experience preferred but not required.

Responsibilities

• Serves as the compliance and privacy manager for assigned areas of the company or an SBU as applicable.
• Assists with regulatory and contract compliance for business managed by the Care Center or supported by corporate compliance.
• Responsible for the implementation of or support of the SBU and/or Corporate Compliance Program, Health Insurance Portability and Accountability Act (HIPAA) compliance, including audits and the preparation for state and customer audits.
• Oversees the implementation and ongoing operation of the Compliance Program for the assigned SBU(s) (if applicable).
• Develops and annually updates a formal written compliance program for the assigned Care Management Center and educates staff about compliance and the appropriate details of the compliance program (if applicable).
• Directs federal and state regulatory and compliance activities.
• Customizes corporate policies where necessary to address state regulatory standards and/or contractual requirements.
• Works with corporate compliance on any customizations that are required due to state regulatory standards (if applicable).
• Serves as a liaison for customers on legal and regulatory issues.
• Chairs the local compliance committee meetings (if applicable).
• Coordinates activities with the Internal Audit and Special Investigations Unit (SIU) on compliance matters including fraud, waste, and abuse auditing and monitoring, as directed.
• Ensures corrective actions are implemented for all known compliance deficiencies.
• Submits reports to the Quality Improvement Committee (QIC), Compliance Committee, Business Unit Manager, and the corporate Compliance Department as appropriate.
• Maintains expertise related to authorization and non-authorization correspondence requirements from the perspective of ERISA, NCQA, URAC, federal regulations and state law.
• Assists in review of standard correspondence, notifying policy content experts of changes to standard policies, and working with IT regarding system changes as it relates to correspondence.
• Attends customer meetings to report on compliance matters (if applicable).
• Serves as central contact for internal and external customers regarding certain parts of the corporate compliance program as assigned or, where applicable, security, HIPAA, and anti-fraud efforts within the assigned Care Center.
• Assists with internal and external audits and reporting, including periodic reports documenting compliance status.
• Oversees Care Center-delegated entities and their compliance activities and assures that compliance data from the delegated entities are reported to the Quality Improvement Committee (QIC) (if applicable).

Benefits

• This position may be eligible for short-term incentives as well as a comprehensive benefits package.
• Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior