Compliance Manager

The Compliance Manager will perform a range of duties including but not limited to evaluating all current and new compliance regulations reviewing company policies and procedures provide subject matter expertise and performing internal audits. The successful candidate will be able to multitask and be an excellent communicator with indepth knowledge of the latest industry trends and regulations.

Key Responsibilities:

• Thought Leadership & Innovation
  • Actively monitor CMS regulatory updates and NCQA standards as well as evolving health care industry regulatory trends and best practices in compliance programs
  • Develop content to communicate the updates to key stakeholders
• Product Development
  • Ensure the MHK solutions remain compliant with applicable regulatory requirements. i.e. Medicare Medicaid NCQA FEP QHP etc.
• Operations Support
  • Work with internal stakeholders to formulating strategy for solutions and partner to communicate a strong vision and strategythat will help to achievethe companys objectives for growth and differentiation.
  • Be a needed resource for MHK various team members to assist in navigating critical or challenging client escalations/discussions as they pertain to any compliance or regulatory issues.
  • Support new client implementations and existing client upgrades of MHK software solutions when needed for Utilization Management Care Management Pharmacy Medical Appeals & Grievances to ensure the success of our clients.
  • Provide ongoing subject matter expertise on the evolving care models and regulatory requirements in Medicare Medicaid and other regulatory bodies
  • Lead communication of the importance of compliance and any changes to regulations that will be shared with clients
  • Facilitate internal audits to ensure ongoing compliance with MHK policies
  • Assist clients with CMS program audit and NCQA accreditation preparation
  • Adapt to competing demands take on new responsibilities and adjust to meet changing priorities.
  • Maintain client PowerPoint presentations that outline identified regulatory updates
  • Track all issues referred to compliance up to and including resolution
  • Identify and assess areas of compliance risk for MedHOK
  • Back up Compliance Officer when needed for daily operations

Skill Requirements:

• Five 5 years proven experience in health plan/managed care operations with utilization management appeals grievance pharmacy case management or quality management.
• Strong knowledge of CMS Medicaid QHP and federal regulations
• Outstanding communication and interpersonal abilities
• An analytical mindset with exceptional organizational skills
• Firsthand experience with operational procedures reporting and auditing
• Methodical and diligent with outstanding planning abilities
• An analytical mind able to see the complexities of procedures and regulations
• Experience researching and summarizing applicable regulatory requirements
• Ability to write updates and memos to Csuite level internal and external clients
• Superb written verbal communication and interpersonal skills
• Excellent in the use of Microsoft applications

Education Requirement:

• Bachelors Degree / Associates Degree or relevant work experience

At MHK we help health plans and pharmacy benefit managers deliver optimal care management across every members health journey. We do this through stateoftheart technology that provides critical insights from member enrollment and maintenance through every stage of care and compliance.

Benefits Snapshot:

• Medical vision and dental plans for full time employees
• 401(k) offered with a generous match
• Benefits begin on first day of the month following employment
• Exercise/Health Club reimbursement opportunity
• Monthly dependent care reimbursementopportunity
• Short Term and Long Term disability
• Basic Term Life and AD&D Insurance

Paid Time Off

• 18 days Paid Time Off
• 15 Company Paid Holidays

EQUAL OPPORTUNITY EMPLOYER VETERANS/DISABLED.