Exceptional Opportunity to join one of the top rated not-for-profit health plans headquartered in the New England area that is rated among the nation’s best health plans for member satisfaction and quality.
The Sr. Manager is a strategic internal business partner serving as the lead subject matter resource for Medicare Advantage regulations and requirements. This position routinely meets with corporate line management to assess business operations against all Medicare Regulatory Requirements and provide in-depth interaction, communication and oversight of all operational departments that touch Medicare relative to meeting CMS requirements.
Develop, maintain, and update an annual compliance risk assessment and monitoring and auditing workplan.
Develop appropriate compliance reports; including dashboard, tracking logs and summary reports that communicate the status of the compliance program to the Compliance Officer and Sr. Company Leaders.
Develop and administer internal auditing & monitoring procedures that assess operational performance against CMS standards. Distribute clear audit reports that describe audit risks and failures.
Work with appropriate business leaders to identify and track CAPS.
Act as point of contact with Centers for Medicare/Medicaid Services (CMS).
Ensure operational preparation for CMS program and compliance audits.
Lead monitoring activities across multiple operational areas to identify areas of potential compliance risk and develop solutions for risk mitigation.
Implement Vendor Oversight Program, including focus on PBM operations.
Oversee a staff that analyzes and communicate new Medicare policy and regulations to all business areas and track implementation and develops annual Compliance training for distribution to all appropriate staff.
Oversee a staff that Provide written and oral advice and guidance regarding compliance requirements that impact the company's products and business
Performs management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
Plans, organizes, staffs, directs and controls the day-to-day operations of the department; develops and implements policies and programs as necessary.
Project management responsibilities within the Compliance team
Managing a team of three or more to complete all required responsibilities
Managing projects in a matrixed environment
Allocation of limited budget dollars for annual auditing purposes
Completion of deliverables in accordance with established timelines and processes
Work with outside entities, including vendors, CMS, external association representatives, consultants and other Health Plan Compliance Professionals to achieve the company’s goals and compliance with CMS requirements.
Knowledge of CMS, Medicare Advantage and Part D regulations/compliance
Superior project management skills
Keen verbal and written communication skills
Critical thinking and analytic skills
Ability to apply government regulations and translate those to business requirements
Ability to manager timelines and multiple priorities and projects
High Degree of Professionalism
Bachelor’s degree. Subjects are Business, Healthcare, Public Policy, Accounting or other related area preferred, Law Degree or Masters is a plus.
6 years of Health Plan experience
5 years of experience working with Medicare products.
4 years of experience working in healthcare compliance, audit, or operations
2 years’ management experience
Experience with overseeing implementation of contract requirements.
Previous experience demonstrating effective communication with federal and state regulatory agencies preferred.
Knowledge of Medicare and CMS regulations and software application tools preferred.
This position offers incredible benefits as well as relocation assistance+ Sign On Bonus.
Salary Depends Upon Experience.
Exceptional Career Opportunity with Upward Mobility.