Senior Compliance Specialist – Care Management Programs

Vālenz® Health

Sr. Compliance Specialist overseeing compliance for Care Management and Utilization Management at Valenz Health.

Posted 6/6/2026full-timeRemote • 🇺🇸 United StatesSeniorWebsite

About the role

Key responsibilities & impact

Serve as the primary compliance liaison for Care Management and Utilization Management operations, providing strategic guidance and oversight to ensure adherence to applicable regulatory and accreditation requirements
Interpret, assess, and operationalize regulatory standards, including CMS Medicare Advantage and Managed Care requirements, NCQA and URAC accreditation standards, Utilization Review and Utilization Management regulations, and 42 CFR Part 2 requirements, as applicable
Oversee and support the organization’s multi-state Utilization Management licensing program by tracking licensing requirements across applicable jurisdictions, coordinating license applications and renewals, maintaining supporting documentation, and partnering with operational leaders to ensure ongoing compliance with licensing conditions and regulatory obligations
Provide compliance guidance and subject matter expertise related to clinical workflows, operational processes, policy development, and system implementations impacting Care operations
Support the full lifecycle management of Care-related policies, standard operating procedures, and associated documentation
Monitor regulatory developments and emerging compliance requirements, evaluate operational impact, and communicate relevant updates and recommendations to key stakeholders
Participate in high-risk initiatives, operational enhancements, and product or process changes to ensure compliance considerations are appropriately addressed
Support organizational readiness for audits, regulatory reviews, and accreditation activities, including NCQA and URAC surveys
Assist with incident response activities involving Care operations, including privacy-related inquiries, compliance investigations, and regulatory escalations
Collaborate with Corporate Compliance and cross-functional teams on issue intake, triage, tracking, remediation, and resolution efforts
Provide education, training, and ongoing guidance to internal stakeholders regarding applicable regulatory and compliance requirements
Maintain accurate and organized documentation to support compliance activities, regulatory inquiries, audits, and accreditation requirements

Requirements

What you’ll need

Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or a related field
5+ years of experience in healthcare compliance, regulatory affairs, clinical operations, or a related healthcare environment
Demonstrated experience supporting Utilization Management, Care Management, and/or Disease Management programs
Working knowledge of CMS regulatory frameworks and managed care compliance requirements
Experience with NCQA and/or URAC accreditation standards and related operational readiness activities
Strong understanding of multi-state healthcare regulatory and compliance environments
A plus if you have…
Experience managing or supporting multi-state Utilization Management licensure programs
Clinical background, such as Registered Nurse (RN) or equivalent clinical experience
Knowledge of 42 CFR Part 2 requirements and related privacy regulations
Experience operating within a Business Associate environment
Relevant professional certification preferred, such as Certified in Healthcare Compliance (CHC), Certified Professional in Healthcare Quality (CPHQ), or equivalent.

Benefits

Comp & perks

Competitive benefits package with generous employer subsidies
Flexible and remote working options
401k with generous employer match and immediate vesting
Personal and professional development opportunities
Supportive family benefits, including paid leave for new family members
Companywide philanthropic program, Valenz Communities Connection

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

healthcare complianceregulatory affairsclinical operationsUtilization ManagementCare ManagementDisease ManagementCMS regulatory frameworksNCQA accreditation standardsURAC accreditation standards42 CFR Part 2 requirements

Soft Skills

strategic guidanceoversightcommunicationcollaborationeducationtrainingorganizational skillsproblem-solvingstakeholder engagementincident response

Certifications

Certified in Healthcare Compliance (CHC)Certified Professional in Healthcare Quality (CPHQ)