Compliance Manager

Presbyterian Healthcare Services

8d • $81,432 - $138,611 • Onsite

About The Position

The Compliance Manager supports the PHP/PIC Compliance Officer in implementing and administering the PHP Compliance Program. Under the officer’s direction, the manager monitors and audits PHP practices to support ongoing compliance and minimize risk through the development, review, and oversight of policies, procedures, business practices, and guidelines addressing state and federal laws and regulatory requirements. The role supports health plan compliance activities across all product lines and helps implement the elements of an effective health plan compliance program, including facilitating audits by external government agencies such as CMS, HSD, DOI, OPM (FEHBP), and DOL (ERISA).

The manager interacts with health plan staff, other PHS staff, regulatory agency staff, and external auditors; helps coordinate responses to regulatory bodies; conducts regulatory research and analysis; and assists with planning, supervising, and coordinating risk assessments and required internal monitoring and auditing activities. The position is based at the Reverend Hugh Cooper Administrative Center in Albuquerque, New Mexico, and works day shifts. It is full-time and exempt.

Requirements

• Bachelor’s degree.
• Five to seven years of experience in healthcare management or law/regulations.
• Managed care health plan experience in Medicare, Medicaid, or Commercial.
• CHC certification or willingness to obtain it within one year.

Responsibilities

• Assist with ensuring PHP maintains written compliance standards and procedures covering necessary areas, and establish and monitor updates, revisions, training, and communication.
• In collaboration with the PHP/PIC Compliance Officer, provide direction and oversight for compliance program auditing, monitoring, and related functions, including risk assessments and contractual obligations.
• Consult with operational departments and subject-matter experts to recommend compliant solutions that support business goals.
• Proactively identify compliance issues and work collaboratively with the PHP/PIC Compliance Officer and operational areas to mitigate risks.
• Assist with implementation and management of compliance training.
• Assist with identifying, implementing, and conducting monitoring and auditing procedures to determine compliance with PHP standards and procedures.
• Support oversight of prompt and thorough investigations of alleged violations of standards and procedures.
• Report potential fraud and noncompliance to the PHP/PIC Compliance Officer and other accountable internal leadership.
• Interact with operational directors and managers, project managers, senior executives, and line staff regarding compliance and related issues.
• Organize and coordinate cross-functional teams addressing compliance issues involving multiple departments or entities.
• Ensure audits, monitoring, tracking, and noncompliance issues are logged timely and accurately in the Governance Risk Compliance Platform (eGRC).
• Perform other duties as assigned.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Short-term disability insurance
• Long-term disability insurance
• Group term life insurance
• Other optional voluntary benefits
• Employee wellness rewards program offering opportunities to earn gift cards through wellness activities

What This Job Offers

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