Senior Manager, Compliance (Health Plan/MCO experience required)

CareSource•Michigan WFH, MI

1d•$94,100 - $164,800

About The Position

The Senior Manager, Compliance provides compliance oversight and organizational leadership, promotes proactive collaboration with business partners, shares insights from analyses, and leads a team that develops and maintains State and Federal regulatory guidebooks, job aids, and other resources. The role supports compliance across delegated and non-delegated Marketplace (Qualified Health Plan), Medicare, and Medicaid services, as applicable to the product area overseen. Strong health plan/MCO compliance and AI experience are preferred. The Senior Manager oversees compliance activities, regulatory relationships, policies and procedures, committee work, compliance tracking, audit readiness, corrective actions, training, and staff performance. The position works with State and Federal regulators and internal market and enterprise leaders to support effective compliance program management and meet regulatory, statutory, corporate, and contractual obligations.

Requirements

Bachelor of Science or Arts degree, or equivalent years of relevant work experience.
At least 7 years of healthcare compliance, managed care, vendor oversight, internal audit, or equivalent experience.
At least 3 years of direct management experience.
Marketplace, Medicare, and Medicaid managed care experience, as applicable to the product oversight.
Ability to develop and foster collaborative relationships with market and enterprise management in a matrix environment.
Strong conflict-resolution, negotiating, and influencing skills.
Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, PowerPoint, SharePoint, and Visio.
Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis.
Leadership ability and a high level of professionalism.
Familiarity with managed care concepts, practices, and procedures.
Ability to develop and maintain expert knowledge of the company’s business and regulatory environments.
Excellent problem-solving and critical-thinking skills.
Excellent verbal, written, and presentation skills for communication in a matrix environment.
Strong attention to detail.
Excellent organization and time-management skills.
Ability to develop, prioritize, and accomplish multiple goals.
Strategic-thinking and decision-making skills.

Nice To Haves

Strong health plan/MCO compliance experience.
AI experience.

Responsibilities

Serve as a compliance leader in the Marketplace, Medicare, and Medicaid arena, as applicable.
Manage relationships with Federal and State regulators, including CCIIO, CMS Federal account managers, State Departments of Insurance, and State Medicaid regulators; oversee regulator meeting agendas, execution, and follow-up.
Oversee compliance activities tracked and performed by compliance staff, including inquiry management, State complaint management, regulatory distribution management, and compliance workplan execution.
Lead and organize Marketplace, Medicare, and Medicaid Compliance Committees and workgroups, representing State and Federal updates across markets.
Oversee policies, procedures, and standard operating procedures to ensure compliance with Federal and State regulatory, statutory, corporate, and contractual standards and obligations.
Remain current on Federal and State laws and regulations and on compliance and delegation oversight best practices and industry standards.
Provide Compliance leadership with feedback about key Marketplace, Medicare, and Medicaid risks for the annual compliance risk assessment.
Assist with execution of the compliance work plan.
Respond to compliance incidents and ensure appropriate reporting and communication with business leaders and compliance team members.
Provide feedback and recommendations to the Compliance Corrective Action Team on ongoing monitoring or improvement of corrective action plans.
Oversee development, maintenance, and reporting of compliance activity tracking to internal and external stakeholders.
Assist with regulatory audits and audit-readiness activities.
Assist with oversight of data validation for internal and external compliance and regulatory reporting.
Serve as a resource for internal departments addressing escalated issues related to external entities.
Identify compliance knowledge gaps and collaborate with business teams to develop training programs to address them.
Provide compliance training to internal and external stakeholders.
Build effective relationships and collaborate with market and corporate leadership and business departments, providing Marketplace, Medicare, and Medicaid compliance expertise on State and Federal requirements.
Maintain positive working relationships with State and Federal regulators and build goodwill and trust for CareSource.
Provide subject matter expertise for Marketplace, Medicare, and Medicaid market and enterprise initiatives.
Keep direct-line leadership and applicable business leadership informed of material regulatory initiatives, compliance concerns, operational issues, corrective actions, and remediations affecting CareSource.
Develop, recruit, retain, and manage compliance staff to meet operational and strategic goals while maintaining compliance with company, State, Federal, and contractual requirements.
Supervise staff, including successful execution of assigned duties, performance management feedback, and disciplinary matters.
Train current and new staff on departmental policies and procedures and develop training materials when necessary.
Keep the management team informed of team performance, projects, and issues.
Perform other job duties as requested.