Job Description
Job Summary:
The Manager, Compliance is responsible for supporting the establishment of a baseline compliance risk, identification of areas of potential exposure, development and alignment of compliance risk management strategies with CareSource goals and objectives, and execution of the compliance program ensuring consistency.
Essential Functions:
Partner with Business Units and internal support functions to help ensure that all compliance requirements have been met; risk is monitored and remediated through testing/ development/ implementation and use
Remain current in federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements as applicable as well as general compliance and delegation oversight best practices and industry standards
Assist with the creation and execution of the annual compliance work plan, risk assessment activities
Manage and drive usage for the compliance tracking systems
Assist in management of applicable compliance oversight functions such as Corrective Action Plan Management, Ongoing Monitoring, and Annual Audits
Report key statistics and trends of core compliance and oversight functions, identifying risk mitigation and performance improvement opportunities to the Delegation Oversight and Compliance Committees as well as to Compliance and Company Leadership
Perform data analysis and reporting activities. Provide and maintain oversight reporting mechanisms, and track and report outcomes from compliance activities. Collect, organize, and distribute reports and documents and recommend enhancements to reporting compliance tools
Track and trend issues to identify compliance risk and performance improvement opportunities; provide input for executive compliance reporting
Assist with regulatory audits and support audit readiness activity
Collaborate with internal resources on the production and communication of compliance related alerts, newsletters and educational materials for all company workforce
Establish effective working relationships and build creditability within the organization to support a culture of compliance based on the Company's core values
Report potential risks, non-compliance or alleged violations to Compliance leadership and plan leadership
May provide management and oversight of professional staff
Perform any other job duties as requested
Education and Experience:
Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
Minimum of five (5) years of healthcare compliance, vendor oversight, internal audit or equivalent experience is required
Managed care or other healthcare related experience is required
Prior management experience is preferred
Direct Centers for Medicare & Medicaid program experience and qualified health plan (i.e. marketplace) experience is required depending on the assigned program
Competencies, Knowledge and Skills:
Advanced capabilities in Microsoft Word, Excel and PowerPoint
Skilled in collaborative management of professional staff
Knowledge of contracting, standards or controls management, preferably from a Managed Care Organization
Knowledge of Medicaid, Federal Marketplace and Medicare Regulatory environment as applicable
Proven success in developing and implementing new practices and controls (with specific improvements)
Experience in a high-growth business environment
Working knowledge of health plan environment is preferred
Strong analytical and statistical skills and attention to detail
Ability to work in a fast-past environment and reprioritize
Effective problem solving skills with attention to detail
Ability to develop, prioritize and accomplish goals
Strong communication skills (both written and verbal)
Strong interpersonal skills & high level of professionalism
Ability to work independently and within a team environment
Effective active listening and critical thinking skills
Display a customer service, member-focused orientation
Licensure and Certification:
None
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$92,300.00 - $161,600.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type:
Salary
Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
