Manager, Medicare Advantage Compliance- Peak Health

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's Degree in healthcare administration, business administration, or related field

EXPERIENCE:

1. Four (4) years of experience in health care compliance

2. Two (2) years of experience in FDR compliance

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Advanced Degree, or equivalent work experience in lieu of

2. Certified in Healthcare Compliance (CHC) or industry equivalent

EXPERIENCE:

1. 3+ years vendor or Vendor Management experience

2. Consulting experience in program implementation in the healthcare industry preferred.

3. Strong written and oral communication skills, with the ability to communicate complex information at all levels of the organization

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Build and implement FDR oversight program including operationalization of third-party engagements and the associated program-level compliance activities to support effective vendor and FDR compliance across Peak Health.

2. Monitor and evaluate the adequacy and effectiveness of the various inter-dependent compliance and related program policies, procedures, processes, systems, and internal controls that will help effectively manage FDR oversight.

3. Review, design, and implement program risk reporting, analytics, and metrics that accurately measure and represent third-party related risk, including the definition of risk appetite, key risk indicators, risk aggregation, and quantification models.

4. Continuously refine and adapt the FDR oversight program in response to emerging trends, evolving industry best practices, and regulatory requirements.

5. Must be an effective change agent and collaborator, possess the skills and willingness to perform duties that are a combination of tactical, transactional, and strategic in nature.

6. Drive regulatory research to support operational objectives, consulting with business SMEs to define the issue and coordinate appropriate regulatory research.

7. Collaborate with leadership on strategy development, working with business partners to ensure appropriate actions taken to prioritize and implement initiatives.

8. Enhance and drive the maturity of the Peak Health Compliance Plan to deliver optimum customer value and employee engagement.

9. Facilitate strategic conversations to assess and determine regulatory requirements for their operational impacts and solutions. Lead and support the identification, removal, or escalation of barriers.

10. Lead and participate in internal compliance programs and projects to ensure scope, timing, and budget are defined, communicated, and executed with appropriate change controls as needed.

11. Review and comply with the Code of Conduct and all applicable company policies and procedures, local, state, and federal laws, and regulations.

12. Maintain program standards, controls, procedures, and policy assurance activities.

13. Support requests for compliance audits, assurance testing, regulatory oversight, and customer inquiries.

14. Support the continued evolution of the compliance program and be a champion for change.

15. Recruits, trains and develops insurance compliance staff members to create a highly effective team.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Ability to stand and walk short distances for eight or more hours.

2. Frequent bending, stooping, or stretching.

3. Ability to lift 30 pounds and push 50 pounds.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment.

2. Some travel may be required to offsite meetings.

SKILLS AND ABILITIES:

1. Ability to work well within ambiguity while delivering successful outcomes.

2. Ability to work under stressful working conditions.

3. Ability to handle and maintain confidential information.

4. Ability to work independently or cooperatively as a team member.

5. Ability to work within multi-disciplinary groups.

6. Ability to work in a fast-paced and rapidly changing environment.

7. Extensive working knowledge of Microsoft Office applications (Excel and Access).

Additional Job Description:

Scheduled Weekly Hours:

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