Shire Veteran Jobs

Job Description

Job Summary

The Compliance Practices Oversight Manager serves as a liaison between the Compliance department and the Sales and Marketing functional departments and is the subject-matter-expert (SME) for guidance on Content Compliance needs and content submission processes for regulatory needs. This team supports compliance audits, implementing corrective action plans (CAPs), supporting legal requirements and needs, and provides metrics/KPI’s on compliance, contract and policy requirements.

The qualified candidate will have a breadth of experience across both managed care operations functions and execution of compliance practices.

Position Scope

• Legal and Compliance support services: Works closely with the Legal, Government Contracts and Compliance departments to ensure proper interpretation of new rules and regulations.

• Rules and regulations: Ensure implementation of federal and state requirements for Medicare and Medicaid for health plan content and for assigned defined projects and programs. Lead impact assessments and define work plans to ensure compliance when policies and regulations change. Lead the department in ongoing work related to policy and procedure documentation, revision, and maintenance.

• Internal/external audits: Collect and validate data/sample/documentation requests; review preliminary findings with stakeholders and prepare/deliver responses.

• CAPs: Work with SMEs to document the CAP and ensure resolution; lead the team and track deliverables to ensure timely

• KPI’s: Report on department policy and compliance KPIs. Manage the strategic direction for the Compliance Practices Oversight team, ensuring the Marketing team is enabled to achieve and maintain consistent compliance across all requirements.

• Leadership: Lead a team of people. Establish the strategic direction, mission, and vision for the Compliance Practices Oversight team, ensuring that Marketing functions are enabled to achieve and maintain consistent compliance across all requirements.

Knowledge/Skills/Abilities

• Establish the strategic direction, mission, and vision for the Compliance Practices Oversight team, ensuring that Sales functions are enabled to achieve and maintain consistent compliance across all requirements

• Organize and lead the team to meet or exceed department compliance objectives

• Demonstrate facilitation, liaison, and negotiation skills to build consensus among diverse stakeholders

• Strong analytical capability, and comprehension of complex topics, including engaging others in understanding key concepts and their relationships

• Support and motivate others across Sales to produce required deliverables and consistently meet deadlines

• Ability to assess deliverables produced by others across Sales for accuracy and sufficiency, then provide effective feedback to ensure consistent quality

• Maintain and enhance industry and company knowledge regarding the key compliance practices outlined in the Position Scope section of this document

• Serve as a resource and subject matter expert for compliance practices in support of all Sales functions

• Lead in the collection, consolidation, and communication of reporting data and metrics relative to each of the compliance practices

Job Qualifications

REQUIRED EDUCATION:

BA/BS or equivalent experience

REQUIRED EXPERIENCE:

• 5+ years experience with managed healthcare operations

• 3-5 years process development/improvement experience

• 3+ years people leadership

• Strong analytical skills

• Strong problem-solving and critical thinking skills

• Highly organized and detail oriented with proof-reading and quality control skills

• Strong interpersonal, written and verbal communication skills; ability to communicate and facilitate communication with individuals at various levels within the organization and with external vendors

• Strong technical skills using Microsoft Applications (i.e. Outlook, Word, Excel, and PowerPoint) and other databases and tools as needed

• Previous experience working with the Centers for Medicare and Medicaid Services (CMS) Health Plan Management System (HPMS)

PREFERRED EDUCATION:

Graduate studies

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

PMP, SixSigma, or equivalent certification

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $72,370.82 - $156,803.45 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.