Manager – Compliance – Duals & D-SNP Product

Manager – Compliance – Duals & D-SNP Product

Requirements

• Bachelor’s Degree Health Care Administration, Compliance or related field or equivalent experience required
• 5+ years Compliance including risk assessment against contract and regulatory requirements, creation and execution of auditing, monitoring and reporting processes, administration of correction action plans, implementation of written policies and procedures, developing and delivering compliance training and education required
• Experience with D-SNP SMAC, regulatory requirements and/or operations required
• Medicare managed health experience required

Responsibilities

• Manage the Dual compliance department functions, including but not limited to, regulatory and D-SNP contract review and interpretation, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual and legal requirements.
• Manage approval and submission of timely and accurate D-SNP State Medicaid Agency (“SMAC”) contract and regulatory required report deliverables not limited to MMCM, CFR and state regulations.
• Oversee all SMAC updates including creating new and updating existing SMACs with CMS, Health Plans, States and consultants/vendors.
• Conduct periodic assessments to ensure compliance against SMAC and regulatory requirements.
• Oversee creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with DSNP regulatory requirements or performance deficiencies.
• Collaborate with CMS, States, Product and Strategy, where applicable, to maintain/improve regulator satisfaction specific to member/provider experience and compliance with regulatory requirements.
• Manage composition and delivery of inquiries and responses to state regulatory agency about D-SNP inquiries. Submission may be done in collaboration with Health Plan.
• Actively engage in regulatory forums to include not limited to dedicated state meetings specific to the _DSNP. Some D-SNP meetings may be integrated with Medicaid forums. Coordinate attendance with Health Plan to ensure dedicated Duals Compliance is present.
• Support responses to “request for proposals” (RFPs) and new business implementations by completing assigned compliance tasks timely and accurately. Collaborate with Health Plan to ensure responses address where appropriate the Duals plan from Medicaid specific requirements. Ensure responses align with D-SNP federal and state requirements as well as support Duals strategy.
• Participate in new Duals business implementations, including the identification and tracking of required SMAC deliverables such as state reporting and requirements beyond D-SNP regulations or state specific program requirements applicable to the D-SNP.
• Design, implement and improve processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and SMAC requirements.
• Create and deliver Duals compliance training for all employees on an annual basis and as needed basis, such as in response to a compliance issue or concern.

Preferred Qualifications

No preferred qualifications provided.