Manager, Compliance Regulatory Distribution Management

CareSource

Jul 17

Applications are closed

Job
Full-time
Senior Level
Banking & Finance
$90.5K - $158.4K

Requirements

Bachelor’s Degree or equivalent years of relevant work experience is required
Juris Doctor (JD) or equivalent law degree is preferred
Minimum of five (5) years of healthcare compliance, government relations, regulatory, or equivalent experience is required
Government Program products is required
Prior management experience is preferred
Managed care or other healthcare related experience is preferred
Competencies, Knowledge and Skills:
Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare, and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entities
Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred
Data analysis ability to produce meaningful insight and drive appropriate action
Demonstrated understanding of compliance and regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid)
Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement
Proven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focus
Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including but not limited to internal leadership at all levels, internal and external legal counsel, Corporate Compliance, State and Federal Regulators
Strong decision making and problem-solving skills
Demonstrated success in working in a matrixed environment
Detail orientated with focus on maintaining accurate information in tools as required
Effective active listening and critical thinking skills
Time management skills including creation and maintenance of project timelines
Advanced level experience in Microsoft Word, Excel and PowerPoint
Licensure and Certification:
Compliance designation preferred

Responsibilities

Leads the overall process, reporting, training and team for the Medicaid regulatory distribution management process which includes validating regulatory implementations
Develop standard processes and protocols to ensure effective Medicaid regulatory implementations through procedure reviews, timely distribution of changes, and appropriate and validated evidence for compliant implementations
Establish a process to create and maintain tool for effective management of overall guidance of Federal Medicaid regulations and the respective connection with each state Medicaid element
Oversee the process, reporting, training and communications to ensure that regulatory updates including, but not limited to, federal Medicaid regulation changes, state Medicaid regulation changes, Medicaid contract changes and any other regulation requirements for maintaining a Medicaid program in each state where CareSource legal entities are in effect are timely disseminated and implemented
Establish consistent and regular communications with business owners and Plan Compliance Officers to discuss activity in the RDM process as well as identification of any risks or issues
Ensure timely and accurate recording and reporting of items entered into the regulatory distribution management tool
Focus on prevention including, but not limited to, assisting with policy and procedure review, reading regulations and summarizing analysis of regulations via white-papers for distribution to the business, and responding to and tracking regulatory questions from the business in respective compliance tracking tools
Manage user acceptance testing (UAT) of the regulatory distribution management tool and promote regulatory distribution management tool and process efficiency and effectiveness by developing, modifying, and implementing changes to the tool and process using feedback received from business partners and other tool users
Maintain positive strategic relationships and support a culture of compliance based on the company's core values
Maintain and enhance current understanding of federal/state laws and regulations regarding Medicaid requirements as well as general compliance best practices and industry standards
Perform data analysis and support evolution to the use of predictive analytics and proactive identification of risk concerning new regulatory requirements and their impact to CareSource
Distribute key statistics and regulatory distribution management trends, identifying risk mitigation and performance improvement opportunities to Compliance and company leadership
Report non-compliance with regulatory implementations to Compliance leadership and plan leadership
Collaborate with Compliance leadership and Plan Compliance Officers in development of effective regulatory distribution management training materials including, but not limited to, training on the tool, education on rules and regulations or government program processes
Perform any other job duties as requested

FAQs

What is the primary role of the Manager, Compliance Regulatory Distribution Management?

The primary role is to lead the Medicaid compliance regulatory distribution management team, serving as the subject matter expert responsible for the overall process, reporting, training, and ensuring effective Medicaid regulatory implementations.

What are the essential functions of this position?

Essential functions include leading the Medicaid regulatory distribution management process, developing standard protocols for compliance, managing communications and training, overseeing regulatory updates, maintaining compliance tracking tools, and performing data analysis to mitigate risks.

What educational background is required for this position?

A Bachelor's Degree or equivalent years of relevant work experience is required, with a Juris Doctor (JD) or equivalent law degree preferred.

How much experience is required for candidates applying for this job?

Candidates must have a minimum of five (5) years of experience in healthcare compliance, government relations, regulatory, or a related field, with prior management experience preferred.

What competencies and skills are necessary for this position?

Necessary competencies include familiarity with government-funded healthcare programs, data analysis skills, strong communication abilities, decision-making and problem-solving skills, attention to detail, time management skills, and advanced proficiency in Microsoft Office applications.

Is prior experience in healthcare or managed care necessary?

Yes, prior experience in managed care or other healthcare-related fields is preferred for this role.

What kind of training will the Manager oversee and develop?

The Manager will collaborate with Compliance leadership to develop effective regulatory distribution management training materials, including training on the regulatory distribution management tool, rules, regulations, and government program processes.

Are there any preferred certifications for this role?

Yes, a compliance designation is preferred for candidates applying for this position.

What tools or systems will the Manager be responsible for?

The Manager will oversee the regulatory distribution management tool, ensuring its effective use, managing user acceptance testing (UAT), and making modifications based on feedback from users.

What is the importance of communication in the role of Manager, Compliance Regulatory Distribution Management?

Communication is essential for discussing RDM process activities with business owners and Plan Compliance Officers, disseminating regulatory updates, and maintaining strategic relationships to support a culture of compliance throughout the organization.

CareSource

Finance

Industry

1001-5000

Employees

Mission & Purpose

Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for 30+ years and we continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be member-first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to over 2.3 million members through plan offerings including Marketplace, Medicare products and Medicaid. With our team of 4,500+ employees located across the country, we continue to clear a path to better life for our members. Visit the "Life" section to see how we are living our mission in the states we serve.