Compliance Program Manager

SCAN Health Insurance • Long Beach, CA

4d • Onsite

About The Position

The purpose of the Compliance Program Manager role is to provide independent, oversight of assigned components of the Medicare Advantage and Prescription Drug (MAPD) compliance program. The role ensures that federal and state regulatory requirements are effectively implemented, monitored, and operating as intended to identify, mitigate, and escalate compliance risks across Medicare lines of business. The position works closely with operational and functional areas to provide regulatory guidance, challenge controls, and assess compliance effectiveness. For Fully Integrated Dual Eligible Special Needs Plans (FIDESNPs), the role supports alignment between CMS and California Department of Health Care Services (DHCS) requirements as part of an integrated Medicare and Medi-Cal oversight framework.

Requirements

• Bachelor's Degree or equivalent experience
• 3-5 years of related experience
• 2-3 years of leadership experience
• Regulatory Expertise- Strong knowledge of applicable federal and state Medicare regulatory requirements, with the ability to interpret guidance and apply it to compliance oversight, risk assessment, and advisory support.
• Analytical and Critical Thinking- Ability to analyze complex regulatory issues, assess compliance risk, evaluate impacts, and identify trends using data, documentation, and operational insights.
• Attention to Detail & Documentation- Demonstrated attention to detail to ensure accuracy, completeness, and audit ready documentation in compliance analyses, reporting, and governance materials.
• Effective Written & Verbal Communication- Ability to clearly and concisely communicate complex compliance requirements, risks, and recommendations to diverse audiences, including operational teams and senior leadership.
• Advisory & Consultative Skills- Ability to provide practical, risk based guidance and professional challenge to business partners while maintaining second line independence and avoiding operational execution.
• Organizational & Time Management Skills- Strong ability to manage multiple priorities, regulatory timelines, and competing demands in a dynamic, highly regulated environment.

Responsibilities

• Accountable as the program owner for assigned Medicare compliance domains by developing compliance programs, providing oversight of program structure, standards, documentation, and effectiveness assessment. Key areas of compliance domains include: [claims, grievance & appeals, Utilization Management, pharmacy, Medicare marketing (this list is not exhaustive)]
• Analyze federal and state regulatory requirements in collaboration with Legal Affairs and operational partners to assess compliance impact, clarify expectations, and support business understanding of regulatory changes and updates.
• Lead regulatory interpretation and compliance impact assessments for new and evolving requirements; translate regulatory guidance into clear compliance expectations and advisory support for business areas.
• Provide regulatory leadership and partnership to cross functional project teams, including initiatives involving regulators, agencies, or external consultants, to inform regulatory strategy and risk considerations, and have a firm understanding of how the regulatory strategies impact the business.
• Partnering with business areas by advising on regulatory strategy options, identifying compliance risks and considerations, and recommending approaches that support compliant implementation.
• Provide compliance advisory support to business areas related to corrective action planning and remediation efforts, including clarifying regulatory expectations and advising on remediation strategies.
• Identify, assess, and escalate compliance risks and emerging issues through established governance and leadership reporting channels.
• Recommend new or revised compliance policies, standards, and controls to support regulatory requirements and sustainable compliance in an evolving business environment, demonstrating the ability to lead through ambiguity.
• Provide compliance guidance and targeted education to assigned functional areas by contributing to training materials, presentations, and educational sessions that reinforce regulatory expectations, while maintaining independence from training administration and tracking.
• Skilled in partnering with and building consensus with business units and stakeholders by facilitating information exchange, communicating regulatory considerations, and elevating risks or concerns as appropriate, while demonstrating a firm understanding of how the regulations impact business and operations.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Benefits

• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO) along with 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

What This Job Offers

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