Compliance Manager
The Compliance Manager will perform a range of duties including evaluating all current and new compliance regulations, reviewing company policies and procedures, providing subject matter expertise, and performing internal audits. The successful candidate will be able to multi-task and be an excellent communicator, with in-depth knowledge of the latest industry trends and regulations.
Key Responsibilities :
- Thought Leadership & Innovation
Actively monitor CMS regulatory updates and NCQA standards as well as evolving health care industry regulatory trends and best practices in compliance programs
Develop content to communicate the updates to key stakeholdersProduct DevelopmentEnsure the MHK solutions remain compliant with applicable regulatory requirements. i.e. Medicare, Medicaid, NCQA, FEP, QHP, etc.
Operations SupportWork with internal stakeholders to formulate strategy for solutions and partner to communicate a strong vision and strategy that will help to achieve the company's objectives for growth and differentiation.
Be a needed resource for MHK various team members to assist in navigating critical or challenging client escalations / discussions as they pertain to any compliance or regulatory issues.Support new client implementations and existing client upgrades of MHK software solutions when needed for Utilization Management, Care Management, Pharmacy, Medical Appeals & Grievances to ensure the success of our clients.Provide ongoing subject matter expertise on the evolving care models and regulatory requirements in Medicare, Medicaid and other regulatory bodiesLead communication of the importance of compliance and any changes to regulations that will be shared with clientsFacilitate internal audits to ensure ongoing compliance with MHK policiesAssist clients with CMS program audit and NCQA accreditation preparationAdapt to competing demands, take on new responsibilities and adjust to meet changing priorities.Maintain client PowerPoint presentations that outline identified regulatory updatesTrack all issues referred to compliance up to and including resolutionIdentify and assess areas of compliance risk for MedHOKBack up Compliance Officer when needed for daily operationsSkill Requirements :
Five (5) years proven experience in health plan / managed care operations with utilization management, appeals, grievance, pharmacy, case management or quality management.Strong knowledge of CMS, Medicaid, QHP and federal regulationsOutstanding communication and interpersonal abilitiesAn analytical mindset with exceptional organizational skillsFirsthand experience with operational procedures, reporting and auditingMethodical and diligent with outstanding planning abilitiesAn analytical mind able to "see" the complexities of procedures and regulationsExperience researching and summarizing applicable regulatory requirementsAbility to write updates and memos to C-suite level internal and external clientsSuperb written, verbal communication and interpersonal skillsExcellent in the use of Microsoft applicationsEducation Requirement :
Bachelor's Degree / Associates Degree or relevant work experienceAt MHK we help health plans and pharmacy benefit managers deliver optimal care management across every member's health journey. We do this through state-of-the-art technology that provides critical insights from member enrollment and maintenance through every stage of care and compliance.
Benefits Snapshot :
Medical, vision, and dental plans for full time employees401(k) offered with a generous matchBenefits begin on first day of the month following employmentExercise / Health Club reimbursement opportunityMonthly dependent care reimbursement opportunityShort Term and Long Term disabilityBasic Term Life and AD&D InsurancePaid Time Off
18 days Paid Time Off15 Company Paid HolidaysEqual Opportunity Employer - Veterans / Disabled. Always Be Aware of Recruitment Fraud
