Compliance Manager Jobs

This role is hybrid/flexible remote. Must be able to come into office 4-5 times a year.

Compensation: $125-145k

As a healthcare organization dedicated to providing quality services to the Central Coast community, Our client is seeking a highly motivated individual to join the team. The ideal candidate will be committed to the mission of improving the health and well-being of members and will bring a combination of skills, experience, and passion to the role.

The team is looking to add a Manager of Compliance to their team.

Responsibilities

• Ensure timely and accurate submission of deliverables in accordance with mandated requirements.
• Supervise Compliance staff, including recruiting, hiring, and retaining qualified team members.
• Oversee job performance and provide guidance and support as needed.
• Contribute to compliance program initiatives, risk assessment, and risk plan development.
• Maintain version control of policies and procedures and coordinate documentation production.
• Cultivate and manage relationships with government partners, associations, and representatives.
• Develop and administer FWA training for all staff members.
• Train internal staff and leaders on the policy and procedure process.
• Prioritize and assign work-related tasks based on department needs and Compliance Leadership instructions.
• Implement the organization's policy and procedure process.
• Communicate new or changed contractual requirements, federal and state statutes and regulations, and program requirements to executive leadership, management, and department leaders.
• Review existing compliance policies and procedures and draft new ones as needed.
• Manage the regulatory requirements process, including reading, reviewing, and summarizing rules and healthcare policies from regulatory agencies.
• Provide guidance on interpreting regulations and health plan guidelines.
• Train and assist departments in adhering to established policies and procedures.
• Collaborate with departments to ensure compliance in operations and participate in internal sub-committees.
• Complete other special projects and duties as assigned.
• Develop and deliver new hire and ongoing training for Compliance staff.
• Ensure timely resolution of investigations and report findings to appropriate parties.
• Track policy and procedure reviews and updates, ensuring timely routing to relevant committees and publication of approved documents.
• Manage the policy and procedure process, including creating and revising the organization's policies and procedures.
• Handle research and responses to questions regarding regulatory compliance.
• Collaborate with the Director of Government Affairs to stay updated on contractual provisions and regulations and communicate changes to staff.
• Assist in tracking and investigating reports of alleged FWA or non-compliance received from external and internal sources.
• Train new staff members as required.
• Prepare and submit routine regulatory reports and analysis to regulatory agencies.
• Conduct performance evaluations for Compliance team members.
• Oversee and manage FWA (Fraud, Waste, and Abuse) compliance processes.
• Ensure that Compliance projects align with and support the organization's Compliance Program goals.
• Assist in managing the department budget, resources, and staff.
• Maintain knowledge of business products and related policies and procedures.
• Provide support in Compliance Department committee-level meetings.

Qualifications

• Proficient in MS Office applications.
• 3-5 years of experience in compliance
• Any relevant certifications (e.g., Certified Compliance Professional) are a plus.
• Bachelor's degree in a relevant field (e.g., business administration, healthcare administration).
• Strong analytical and problem-solving abilities.
• Ability to train and develop staff members.
• Excellent communication and interpersonal skills.
• Strong understanding of interpreting and applying regulations and guidelines.
• Detail-oriented with strong organizational and time management skills.
• In-depth knowledge of regulatory requirements and healthcare policies.
• 3-5 years of experience in healthcare- specifically managed plans

Compensation

• $125,000-145,000 base salary

This role is hybrid/flexible remote. Must be able to come into office 4-5 times a year.