Medicare Compliance Program Manager

We have an opportunity to join the Alliance as the Medicare Compliance Program Manager in the Compliance Department.
There is one position that can be filled in our Scotts Valley, Merced or Salinas offices or remotely for those residing in California.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Chief Compliance Officer, this position:

• Acts as the Compliance Division's Medicare compliance subject matter expert
• Performs program planning and design in support of the development, implementation, and on-going management of the Alliance's Centers for Medicare and Medicaid (CMS)-compliant Compliance Program
• Supports organizational efforts related to building the Alliance's Dual Eligible Special Needs Plan (D-SNP) product
• Guides and supports Alliance departments in confirming and maintaining compliance with CMS requirements

ABOUT THE TEAM
The Compliance Department promotes a culture of compliance and helps Alliance staff understand and follow the Compliance Plan, applicable laws, regulations and obligations, and the Alliance's Code of Conduct. The Compliance Department is a resource for Alliance staff, assisting the organization in carrying out its mission with transparency and integrity and in accordance with the Alliance's legal and regulatory obligations.
THE IDEAL CANDIDATE WILL

• Have strong experience designing , and building , and operating effective Medicare Advantage and/or D-SNP Compliance Programs
• Have excellent leadership skills, with the ability to influence and motivate team members and peers to achieve program goals and objectives
• Be a trusted advisor with excellent analytical and interpersonal skills with emphasis on collaboration
• Have skill in interpreting complex Medicare compliance requirements and , implementing them into compliance operations , and supporting others in doing the same
• Have strength in process improvement and champion change management to support the organization to adopt new Medicare Compliance Programs, policies & processes
• Desirable experience in: Working knowledge of Medi-Cal and related regulations

WHAT YOU'LL NEED TO BE SUCCESSFUL
To read the full position description, and list of requirements click here .

• Knowledge of:
• Healthcare regulatory policies
• Principles and techniques associated with healthcare compliance functions
• Methods and techniques of Medicare Advantage or D-SNP implementation and/or operational program management
• Research, analysis, and reporting methods
• Principles and practices of program development, implementation, management, and evaluation
• State and Federal legislative processes, including the regulatory environment
• Ability to:
  • Ability to work effectively with cross-functional teams and build strong relationships with stakeholders
  • Ability to act as a technical resource and explain complex laws, regulations, processes, and programs related to areas of responsibility
  • Ability to demonstrate strong analytical skills, accurately collect, manage and analyze data, identify issues, offer recommendations and potential consequences, and mitigate risk
  • Ability to lead or assist with the development and implementation of programs, projects, systems, policies, and procedures
  • Ability to understand contractual language and its impact on vendor obligations and performance
• Education and Experience:
  • Bachelor's degree in Business, Health Administration, Public Policy, or a related field
  • A minimum of eight years of experience in a managed care setting which included a minimum of five years of Medicare-Advantage and/or D-SNP experience and three years of experience related to Medicare compliance (a Master's degree may substitute for two years of the general managed care experience); or an equivalent combination of education and experience may be qualifying

OTHER DETAILS

• While this position is connected to one of our Alliance offices, we are in hybrid remote/in-office work environment right now and we anticipate that the interview process will take place remotely.
• Our Alliance office locations have officially re-opened as of May 2, 2022 and while some employees may work in full-time telecommute schedules, attendance at quarterly company-wide events or department meetings will be expected.
• Based on the nature of work, this position may require onsite presence, which is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.
The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).
Merced pay range
$94,178 - $150,696 USD
Scotts Valley pay range
$103,487 - $165,589 USD
Salinas pay range
$103,487 - $165,589 USD
Additionally, all positions at the Alliance are required to meet these minimum qualifications.
OUR BENEFITS

• Medical, Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US
We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.
Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Merced, Monterey and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet .
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer
At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.