Compliance Manager
Core
Runs the day-to-day compliance program for a multi-state peer-workforce organization serving individuals with serious mental illness under value-based healthcare arrangements.
Role type
Senior IC Compliance Manager (Healthcare)
Builds
Compliance policies, training programs, audit plans, and reporting dashboards for a Medicaid/Medicare Advantage peer support organization.
Domain
Healthcare compliance, Medicaid/Medicare Advantage, Peer Support Services
Required skills
Medicaid/Medicare Advantage compliance, Federal fraud and abuse laws (Anti-Kickback, False Claims Act), HIPAA, Multi-state regulatory navigation, Audit execution, Investigation management, Policy development, Vendor/Contractor screening, Corrective action planning
Preferred skills
Experience with OIG General Compliance Program Guidance, Peer certification requirements, 42 C.F.R. Part 2 knowledge
Technologies
OIG List of Excluded Individuals and Entities, System for Award Management, State Medicaid exclusion lists
Responsibilities
Maintain compliance policy library and state-specific addenda; Execute annual audit and monitoring plans; Conduct compliance investigations and manage corrective actions; Deliver fraud, waste, and abuse training; Administer compliance hotline and reporting routes; Oversee credentialing, background checks, and exclusion screening.
Seniority
Senior, hands-on IC
