Compliance Manager Position Available In Hillsborough, Florida

Compliance Manager
Tampa, FL, United States

JOB DESCRIPTION

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 multi-task and be an excellent communicator, with in-depth 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 strategy that will help to achieve the company’s 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 C-suite level internal and external clients
Superb written, verbal communication and interpersonal skills
Excellent in the use of Microsoft applications

Education Requirement:

Bachelor’s Degree / Associates Degree or relevant work experience At MHK we help health plans and pharmacy benefit managers deliver optimal care management across every member’s health journey. We do this through state-of-the-art 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 reimbursement opportunity 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. JOB INFO

Job Identification
2024165
Job Category
Operations
Posting Date
04/16/2025, 12:01 PM
Degree Level
Bachelor’s Degree
Job Schedule
Full time
Job Shift
Day
Locations 3031 North Rocky Point Drive West, Tampa, FL, 33607, US