Senior Compliance Administrator - Clinical, SNP Model of Care, Care Management, Quality, STARs
Core
Individual contributor and subject matter expert supporting the day-to-day execution of the Medicare Compliance Advisory program, ensuring alignment with CMS requirements and federal/state regulations.
Role type
Senior Compliance Administrator (Medicare/CMS)
Builds
Regulatory guidance, compliance workplans, audit readiness, and corrective action plans for Medicare Advantage/Part D programs.
Domain
Healthcare / Medicare Compliance / Regulatory
Required skills
Medicare regulations knowledge, regulatory research, risk assessment, audit support, corrective action planning, policy review, stakeholder liaison, compliance training
Preferred skills
CHC certification, CMS audit protocol familiarity, matrixed environment experience, clinical licensure (RN, LPN, Pharmacist, CPhT, Case Management)
Technologies
CMS systems, regulatory reporting tools
Responsibilities
Execute Medicare Compliance Program, interpret federal/state requirements, develop regulatory communications, support report preparation and submission, identify compliance risks, lead root cause analysis, support audit execution, evaluate remediation plans, contribute to compliance training, review policies and processes, monitor regulatory developments.
Seniority
Senior, hands-on IC
