At Wellframe, we reimagine healthcare relationships through a new approach that uses high-tech to deliver the high-touch support people need, when and where they need it. We call it Digital Health Management. Our comprehensive suite of Digital Health Management solutions for care management, advocacy, and navigation help organizations forge more meaningful connections with members, across their healthcare journey. 

Wellframe was founded to counter a pressing industry problem: the healthcare system has struggled to find ways to support people in between care settings, at scale. We believe health plans are in the best position to advocate for their members as they navigate their health and care, but know that technology alone can’t help us achieve this ambition. That’s why our team of physicians, clinicians, public health experts, data scientists, engineers, and healthcare industry experts ensure our patented technology works in service of the person-to-person connections that make healthcare work best.

Role Overview

Reporting directly to the Senior Corporate Counsel, the Senior Compliance Manager will be responsible for designing, coordinating, executing and overseeing Wellframe’s compliance program. As part of Wellframe’s Legal team, the Senior Compliance Manager will help interpret, communicate and implement compliance requirements and expectations throughout Wellframe and advise internal stakeholders on appropriate compliance risk mitigation strategies. This individual will serve as the subject matter expert on CMS compliance matters including answering questions from other teams within Wellframe and help deliver on compliance requirements for Wellframe’s customer base. In this role, this individual will be responsible for ongoing compliance with CMS and the various state regulatory requirements.

Areas of Responsibility:

Regulatory Compliance (40%)

• Manage compliance policies; ensure policies are up to date through periodic review by subject matter experts; communicate policy changes as needed.
• Stay current with CMS regulatory guidance and other relevant federal and state compliance laws and regulations and modify the compliance program accordingly to remain compliant, as well as consistent with industry best practices.
• Advise on and negotiate CMS and other regulatory provisions in customer, vendor, and partner contracts

Corporate Compliance (30%)

• Oversee all aspects of internal training for Wellframe, including, for example, new employee orientation, annual online training and department-specific training.
• Manage enablement materials for cross-functional stakeholders on current and emerging compliance issues to influence how Wellframe thinks about relevant laws.
• Document and review potential conflicts of interest.
• Assist with maintenance of Wellframe’s Code of Conduct and Business Ethics and Employee Handbook.
• Maintain records and documentation necessary to demonstrate compliance with applicable laws and regulations.
• Assist with assessments assigned by customers and prospects.

Advisory (30%)

• Evaluate new products and programs for potential compliance issues, and oversee remediation when issues arise; translate legal requirements into actionable advice for product and engineering teams.
• Answer questions from internal departments about various topics and participate on teams that need to integrate or deliver compliance requirements.
• Work across all departments to identify compliance risks, trends, vulnerabilities, and research solutions for risk mitigation.
• Update senior management and department directors on changes in compliance requirements, expectations, and regulatory requirements.

Education, Experience, & Skills Required

• Minimum of 7 years work experience in monitoring compliance with Medicare and Medicaid regulations, preferably within the health insurance industry.
• Bachelor’s degree in health information management, business, healthcare, or related field; JD a plus but not required.
• Certification in Healthcare Compliance required.
• Experience with medical device regulation preferred.
• Demonstrated ability to comprehend and interpret regulatory, legislative, and contractual mandates.
• Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles.
• Record of collaboration and effective management of a compliance program.

Behaviors & Traits Required:

• Excellent analytic skills and ability to effectively establish and achieve compliance requirements in collaboration with other teams.
• Acts independently; determines methods and procedures on new, special or unique tasks or projects.
• Strong written and verbal communication skills.
• Comfortable with changing requirements and navigating ambiguity.
• Generally adept at picking up new technologies.
• Support Wellframe’s mission by exhibiting Tenacity, Humility, and Collaboration.

Wellframe, Inc. is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status or any other characteristic protected by local, state, or federal laws, rules, or regulations.

This posting is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee and any percentages listed are approximate. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.