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Medicare Compliance Manager | Managed Care

San Diego, CA
We’re working on behalf of San Diego’s only locally based commercial health plan. With a personal approach and a superior network of medical groups and physicians, the health plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.  The health plan has multiple products and service lines, including but not limited to, HMO, PPO, POS, Individual, Medicare Supplement, ASO, Self-funded, risk adjusted contracts, dental, and government contracts with CalPers and the Exchange. The health plan takes great pride in its commitment to customer service, and is the only plan in California to achieve a 4 out of 5 rating for Customer Satisfaction in the National Committee for Quality Assurance (NCQA) Private Health Insurance Plan Ratings 2015-2016.

Looking for a great opportunity?  We seek candidates with strong knowledge of Medicare Part C and D compliance and/or operations and  three (3) or more years of compliance experience within the health care industry for the role of Manager, Compliance.  The person in this role will be responsible for the development, implementation, and maintenance of an effective compliance program in accordance with state and federal statutory and regulatory requirements and healthcare plan policies and procedures. She/he will be responsible for providing effective leadership for the health plan in the areas of: commercial and government program health plan compliance; privacy; fraud, waste and abuse; government contract compliance; and delegation oversight. She/he will be responsible for plan-wide audit activities, including audits of the health plan’s internal business units and first tier, downstream and related entities (FDRs). She/he will directs follow-up assessment of newly implemented legislative and regulatory requirements to ensure compliance. She/he will participate in the development of risk assessment tools and in conducting risk assessments for business units and FDRs, and develop a comprehensive audit plan tailored to address the relative risks presented by each business unit and FDR.

Candidates must have a Master’s degree in business, law, health care administration or related field, or JD. Must have three (3) or more years of compliance experience within the health care industry. Must have three (3) years’ experience in position requiring high levels of cooperation and collaboration. Must have strong working knowledge of Medicare Part C and D compliance and/or operations. Must have experience in a leadership role, ideally leading and implementing a comprehensive compliance program.

The role offers  highly competitive compensation and benefits. This is an excellent opportunity to join one of the top-rated health plans in California (as measured by the CAHPS satisfaction survey) that serves a growing number of companies, large and small, in San Diego and southern Riverside counties. For more information call 941.739.1400 or submit your resume now by clicking on the button below that says “Apply Now.”

Eric Boelkins
Edge Recruitment Solutions
888.666.2450 or 941.739.1400
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