Medicare Compliance Program Manager

SCAN Health Plan • Long Beach, CA

1d • Hybrid

About The Position

The Job Leads compliance program administration, technology enablement, process improvement, analytics, and regulatory implementation activities that support the effectiveness and maturity of the Compliance Program. Partners with Compliance, business operations, and technology teams to ensure regulatory requirements are effectively implemented, monitored, and documented while identifying opportunities to leverage technology, workflow automation, data analytics, and artificial intelligence to strengthen program oversight, operational efficiency, and regulatory compliance.

Requirements

• Bachelor's Degree in Healthcare Administration, Business Administration, Information Systems, Compliance, Public Health, Health Informatics, Project Management, or a related field, or equivalent combination of education and experience
• 5+ years of progressive experience in healthcare compliance, Medicare Advantage, regulatory operations, program administration, business systems, technology implementation, project management, or a related field.
• Demonstrated experience leading cross-functional initiatives, managing complex projects, and driving business process improvements required.
• Experience gathering business and technical requirements, coordinating user acceptance testing, developing reports, dashboards, and analytics, and supporting system implementations and enhancements required.
• Strong knowledge of Medicare Advantage, Part D, CMS regulations, or another highly regulated environment required.
• Strong knowledge of Medicare Advantage, Part D, healthcare compliance, and regulatory requirements.
• Ability to translate regulatory and business requirements into actionable implementation plans, process improvements, and technology-enabled solutions
• Strong project and program management skills, including the ability to lead cross-functional initiatives and drive accountability without direct authority.
• Demonstrated analytical and problem-solving skills, with the ability to interpret data, identify trends, and support informed decision-making.
• Proficiency with technology, reporting, workflow automation, and emerging technologies, including artificial intelligence and data analytics
• Excellent verbal and written communication skills, with the ability to effectively engage stakeholders at all levels of the organization
• Ability to manage multiple priorities in a fast-paced environment while maintaining attention to detail and meeting deadlines
• Strong collaboration and relationship-building skills with the ability to work effectively across business, operational, and technical teams.
• A background check is required.

Nice To Haves

• Experience leveraging technology, workflow automation, analytics, and/or emerging technologies to improve operational efficiency and program effectiveness preferred.
• Rebels who are curious about AI and its power to transform how we operate and serve our members.

Responsibilities

• Lead and support compliance program administration activities, initiatives, and projects designed to strengthen the effectiveness, scalability, and maturity of the Compliance Program. Focus areas include policies and procedures, training and education, departmental communications, compliance investigations, reporting, etc.
• Identify opportunities to leverage technology, analytics, workflow automation, and artificial intelligence to improve Compliance Program effectiveness, operational efficiency, and regulatory compliance. Work with stakeholders to define and translate business requirements into systems specifications.
• Support the implementation, optimization, administration, and continuous improvement of compliance technology platforms, reporting solutions, regulatory libraries, and workflow management tools.
• Coordinate and monitor implementation of federal and state regulatory requirements, ensuring actions are assigned, tracked, documented, and completed in collaboration with Compliance and business stakeholders.
• Serve as a liaison between Compliance, business operations, and technology teams to facilitate successful project execution, regulatory implementation, and program initiatives.
• Analyze compliance and operational processes to identify opportunities for standardization, optimization, automation, and continuous improvement.
• Develop and maintain dashboards, reports, metrics, and data-driven insights that support compliance oversight, program performance monitoring, and leadership decision-making.
• Translate regulatory, compliance, and business requirements into implementation plans, process improvements, system enhancements, and technology-enabled solutions.
• Facilitate workgroups, stakeholder meetings, and governance activities; monitor project milestones, risks, dependencies, and implementation outcomes.
• Develop implementation documentation, training materials, communication plans, and user adoption strategies to support successful deployment of program initiatives and technology solutions.
• 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