Sr Manager Corporate Compliance-Special Needs Plans (Clinical)
Core
Senior Manager responsible for Medicare and Medicaid compliance programs, risk assessment, and regulatory reporting for Special Needs Plans (SNPs) within a highly matrixed healthcare organization.
Role type
Senior Manager, Corporate Compliance (Healthcare Regulatory)
Builds
Compliant Medicare Advantage and Special Needs Plan programs for CVS Health/Aetna
Domain
US Healthcare, Medicare/Medicaid, Special Needs Plans (SNP)
Deliverable
client delivery
Required skills
Medicare/Medicaid compliance expertise, regulatory rule analysis, risk assessment, auditing, corrective action oversight, project management, stakeholder influence, root cause analysis
Preferred skills
Clinical or operational background (RN/LPN/SW), SNP Model of Care (MOC) administration, external quality review oversight
Technologies
Archer, Microsoft products
Responsibilities
Serve as market compliance officer for assigned SNPs; Track, analyze, and interpret CMS and state regulations; Lead and implement effective Compliance Programs including risk assessment and auditing; Develop compliance strategies to prevent and mitigate risks; Support and facilitate communications with regulators; Lead external regulatory review and audit activities; Monitor and audit compliance work plans and direct remediation projects
Seniority
Senior, hands-on IC with strategic oversight
