Compliance Manager Position Available In Hillsborough, Florida

Id :

2024165,

Title :

Compliance Manager,

Category :

Operations,

RequisitionType :

Professional,

JobGrade :

null,

RequisitionId :

300001715648147,

ExternalPostedStartDate :

2025-04-16T18:01:42 00:00,

JobLevel :

null,

JobSchedule :

Full time,

JobShift :

Day,

StudyLevel :

Bachelor’s Degree,

InternationalTravelRequired :

null,

ExternalContactName :

null,

ExternalContactEmail :

null,

ContractType :

null,

ExternalPostedEndDate :

null,

JobFamilyId :

300000001871202,

GeographyId :

300000001905819,

GeographyNodeId :

100005381262851,

ExternalDescriptionStr :

The Compliance Manager will perform a range of duties including, but not limited to, evaluating all current and newpliance regulations, reviewingpany policies and procedures, provide subject matter expertise and performing internal audits. The successful candidate will be able to multi-task and be an excellentmunicator, 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 inpliance programs Develop content tomunicate the updates to key stakeholders Product Development Ensure the MHK solutions remainpliant 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 tomunicate a strong vision and strategy that will help to achieve thepany’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 anypliance 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 Leadmunication of the importance ofpliance and any changes to regulations that will be shared with clients Facilitate internal audits to ensure ongoingpliance with MHK policies Assist clients with CMS program audit and NCQA accreditation preparation Adapt topeting demands, take on new responsibilities and adjust to meet changing priorities. Maintain client PowerPoint presentations that outline identified regulatory updates Track all issues referred topliance up to and including resolution Identify and assess areas ofpliance 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 Outstandingmunication 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” theplexities 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, verbalmunication 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 andpliance.

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.

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