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
Execution of the compliance program ensuring consistency
Partner with Business Units and internal support functions to help ensure that all compliance requirements have been met
Remain current in federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements as applicable
Assist with the creation and execution of the annual compliance work plan, risk assessment activities
Manage and drive usage for the compliance tracking systems
Report key statistics and trends of core compliance and oversight functions
Perform data analysis and reporting activities
Collaborate with internal resources on the production and communication of compliance related alerts, newsletters and educational materials
Establish effective working relationships and build credibility within the organization

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

Manager, Compliance

Key skills