Manager, Compliance

Job Summary:

The Manager, Compliance is responsible for supporting the establishment of a baseline compliance risk, identification of areas of potential exposure, development and alignment of compliance risk management strategies with CareSource goals and objectives, and execution of the compliance program ensuring consistency.

Essential Functions:

• Partner with Business Units and internal support functions to help ensure that all compliance requirements have been met; risk is monitored and remediated through testing/ development/ implementation and use
• Remain current in federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements as applicable as well as general compliance and delegation oversight best practices and industry standards
• Assist with the creation and execution of the annual compliance work plan, risk assessment activities
• Manage and drive usage for the compliance tracking systems
• Assist in management of applicable compliance oversight functions such as Corrective Action Plan Management, Ongoing Monitoring, and Annual Audits 
• Report key statistics and trends of core compliance and oversight functions, identifying risk mitigation and performance improvement opportunities to the Delegation Oversight and Compliance Committees as well as to Compliance and Company Leadership
• Perform data analysis and reporting activities. Provide and maintain oversight reporting mechanisms, and track and report outcomes from compliance activities. Collect, organize, and distribute reports and documents and recommend enhancements to reporting compliance tools
• Track and trend issues to identify compliance risk and performance improvement opportunities; provide input for executive compliance reporting
• Assist with regulatory audits and support audit readiness activity
• Collaborate with internal resources on the production and communication of compliance related alerts, newsletters and educational materials for all company workforce
• Establish effective working relationships and build creditability within the organization to support a culture of compliance based on the Company's core values
• Report potential risks, non-compliance or alleged violations to Compliance leadership and plan leadership
• May provide management and oversight of professional staff
• Perform any other job duties as requested

Education and Experience:

• Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
• Minimum of five (5) years of healthcare compliance, vendor oversight, internal audit or equivalent experience is required
• Managed care or other healthcare related experience is required
• Prior management experience is preferred
• Direct Centers for Medicare & Medicaid program experience and qualified health plan (i.e. marketplace) experience is required depending on the assigned program

Competencies, Knowledge and Skills:

• Advanced capabilities in Microsoft Word, Excel and PowerPoint
• Skilled in collaborative management of professional staff
• Knowledge of contracting, standards or controls management, preferably from a Managed Care Organization
• Knowledge of Medicaid, Federal Marketplace and Medicare Regulatory environment as applicable
• Proven success in developing and implementing new practices and controls (with specific improvements)
• Experience in a high-growth business environment 
• Working knowledge of health plan environment is preferred
• Strong analytical and statistical skills and attention to detail
• Ability to work in a fast-past environment and reprioritize
• Effective problem solving skills with attention to detail
• Ability to develop, prioritize and accomplish goals
• Strong communication skills (both written and verbal)
• Strong interpersonal skills & high level of professionalism
• Ability to work independently and within a team environment
• Effective active listening and critical thinking skills
• Display a customer service, member-focused orientation

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business