Associate Director, Compliance, Managed Care
CareSource
full-time
Posted on:
Location Type: Office
Location: United States
Visit company websiteExplore more
Salary
💰 $113,000 - $197,700 per year
Job Level
About the role
- The Associate Director, Compliance is responsible for establishing a baseline of compliance risk
- Identifying areas of potential exposure
- Developing and aligning compliance risk management strategies with CareSource goals and objectives
- Executing the compliance program ensuring effectiveness
- Serves as the program compliance leader for an assigned Medicaid, Medicare, or Marketplace CareSource program
- Building and maintaining a strong relationship and goodwill with the relevant regulatory entity
- Assist the Program or Regional Compliance Officer with the implementation of an effective compliance program
- Oversee all assigned program compliance activities performed and tracked by compliance staff
- Build and maintain strong partnerships with business units
- Remain current and help drive interpretation and implementation of federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements
- Provide feedback to Compliance leadership concerning key risks in assigned program
- Manage and drive effective usage of compliance tools and data for the compliance tracking systems
- Track and trend issues to identify compliance risk and performance improvement opportunities
- Assist with regulatory audits
Requirements
- Bachelor’s Degree in Business/Healthcare Administration or a related discipline, or equivalent years of relevant work experience
- A minimum of five (5) years of relevant work experience within health plan operations is required, with at least three (2) years directly involved in government programs or managed care compliance activities preferred
- Two (2) years of direct management experience is required
- Specific Marketplace, Medicare and Medicaid managed care experience is required as applicable
- Advanced capabilities in MS Office suite including Microsoft Word, Excel and PowerPoint
- Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis
- Working knowledge of health plan environment is preferred
- Certified in Healthcare Compliance (CHC) preferred
Benefits
- Comprehensive total rewards package
- Substantial and comprehensive total rewards package
- Bonus tied to company and individual performance
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
compliance risk managementcompliance program executiondata reporting designclaims processingfinance analysisperformance improvementregulatory auditsmanaged care compliancehealth plan operationsrisk identification
Soft Skills
relationship buildingleadershipcommunicationorganizational skillspartnership developmentfeedback provisionstrategic alignmentproblem-solvingteam managementinterpersonal skills
Certifications
Certified in Healthcare Compliance (CHC)