CareSource
Location: all cities,WV, USA
Date: 2024-12-12T08:52:07Z
Job Description:
Job Summary:The Manager, Compliance is responsible for ensuring and documenting CareSource AR and CareSource PASSE have an effective ethics and compliance program. This includes supporting the establishment of a baseline compliance risk, identifying areas of potential exposure, developing and aligning compliance risk management strategies with CareSource goals and objectives, and executing the compliance program ensuring consistency.Essential Functions:Serves as the CareSource Arkansas PASSE compliance officer.Serves on the AR leadership team with matrixed reporting to the market.Acts as the primary point of contact with state regulators for all PASSE compliance issues, building goodwill and trust with regulators.Ensures and oversees that regulatory requirements impacting products offered in Arkansas are tracked and implemented in a timely manner utilizing the process and forms prescribed by the corporate Compliance team.Aligns, oversees, and maintains Arkansas compliance and regulatory operations in accordance with agreed-upon best practices and corporate standards. Actively participates in Corporate Compliance hosted meetings to identify and implement best practices and templates.Drafts at least quarterly status reports for the Corporate Compliance Officer and/or Audit Committee of the Board.Partners with Business Units and internal support functions to ensure that all compliance requirements have been met; monitors and remediates risk through testing, development, implementation, and use.Provides review and input on proposed laws. Remains current in federal/state laws and regulations regarding Medicaid requirements and general compliance and delegation oversight best practices and industry standards.Assists with the creation and execution of the annual compliance work plan and risk assessment activities.Assists in management of applicable compliance oversight functions such as Corrective Action Plan Management, Ongoing Monitoring, and Annual Audits.Reports key statistics and trends of core compliance and oversight functions, identifying risk mitigation and performance improvement opportunities to the Delegation Oversight and Compliance Committees as well as to Compliance and Company Leadership.Performs data analysis and reporting activities. Maintains oversight reporting mechanisms, tracks and reports outcomes from compliance activities, collects, organizes, and distributes reports and documents, and recommends enhancements to reporting compliance tools.Tracks and trends issues to identify compliance risk and performance improvement opportunities; provides input for executive compliance reporting.Assists with regulatory audits in collaboration with the CareSource external audit team, EQRO regulatory audits, and site visits.Establishes effective working relationships and builds credibility within the organization to support a culture of compliance based on the Company's core values.Reports potential risks, non-compliance, or alleged violations to Compliance leadership and plan leadership.Performs any other job duties as requested.Education and Experience:Bachelor of Science/Arts degree or equivalent years of relevant work experience is required.Minimum of five (5) years of healthcare compliance, vendor oversight, internal audit, or equivalent experience is required.PASSE or Medicaid Managed Care experience is required.Prior management experience is preferred.Established relationships with the Arkansas Department of Human Services (DHS), Centers for Medicare & Medicaid Services (CMS), state Departments of Insurance, and/or state Medicaid Departments is preferred.Competencies, Knowledge and Skills:Advanced capabilities in Microsoft Word, Excel, and PowerPoint.Skilled in collaborative management of professional staff.Knowledge of contracting, standards, or controls management, preferably from a Managed Care Organization.Knowledge of Medicaid, Federal Marketplace, and Medicare Regulatory environment as applicable.Proven success in developing and implementing new practices and controls (with specific improvements).Experience in a high-growth business environment.Working knowledge of the health plan environment is preferred.Strong analytical and statistical skills and attention to detail.Ability to work in a fast-paced environment and reprioritize.Effective problem-solving skills with attention to detail.Ability to develop, prioritize, and accomplish goals.Strong communication skills (both written and verbal).Strong interpersonal skills & high level of professionalism.Ability to work independently and within a team environment.Effective active listening and critical thinking skills.Displays a customer service, member-focused orientation.Licensure and Certification:None.Working Conditions:Ability to travel to the Little Rock, Arkansas office when required.General office environment; may be required to sit or stand for extended periods of time.Compensation Range:$81,450.00 - $142,560.00. CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.Compensation Type:SalaryCompetencies:- Create an Inclusive Environment- Cultivate Partnerships- Develop Self and Others- Drive Execution- Influence Others- Pursue Personal Excellence- Understand the BusinessThis job description is not all-inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.#J-18808-Ljbffr
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