Clinical Compliance Manager

A company is looking for a Manager, Business Standards and Oversight.

Key Responsibilities

Provide oversight for regulatory and contractually required document management related to Utilization Management and Care Management

Coordinate with various teams to ensure compliance with NCQA standards and support operational processes

Lead preparation for external audits and provide feedback regarding audit results and necessary corrective actions

Required Qualifications

Bachelor's Degree in a Health Care related field or equivalent work experience

5+ years of experience in regulatory, audit, oversight, or healthcare delivery

Previous leadership experience in hiring, training, and managing staff performance

Clinical licensure is preferred and required if managing policy

Experience with compliance and audit readiness is essential