Compliance Manager
| Company | Hearst |
|---|---|
| Location | Tampa, FL, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | |
| Experience Level | Senior |
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 regulations
- Outstanding communication and interpersonal abilities
- An analytical mindset with exceptional organizational skills
- Firsthand experience with operational procedures, reporting and auditing
- Methodical and diligent with outstanding planning abilities
- An analytical mind able to “see” the complexities of procedures and regulations
- Experience researching and summarizing applicable regulatory requirements
- Ability to write updates and memos to C-suite level internal and external clients
- Superb written, verbal communication and interpersonal skills
- Excellent in the use of Microsoft applications
Responsibilities
- 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 stakeholders
- Ensure the MHK solutions remain compliant with applicable regulatory requirements. i.e. Medicare, Medicaid, NCQA, FEP, QHP, etc.
- Work with internal stakeholders to formulating 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 bodies
- Lead communication of the importance of compliance and any changes to regulations that will be shared with clients
- Facilitate internal audits to ensure ongoing compliance with MHK policies
- Assist clients with CMS program audit and NCQA accreditation preparation
- Adapt to competing demands, take on new responsibilities and adjust to meet changing priorities.
- Maintain client PowerPoint presentations that outline identified regulatory updates
- Track all issues referred to compliance up to and including resolution
- Identify and assess areas of compliance risk for MedHOK
- Back up Compliance Officer when needed for daily operations
Preferred Qualifications
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No preferred qualifications provided.