Medicare Compliance Manager

4 days ago


Camarillo, California, United States Gold Coast Health Plan Full time
Job Summary

Gold Coast Health Plan is seeking a highly skilled Medicare Compliance Manager to join our team. As a key member of our Compliance Department, you will be responsible for developing, administering, and overseeing the Medicare Compliance Program and initiatives in alignment with our overall D-SNP strategy.

Key Responsibilities
  • Develop and implement compliance projects and program activities focusing on integrating regulatory requirements, industry standards, and organizational policies for Medicare, Medi-Cal, and Knox Keene.
  • Manage and oversee the compliance program to ensure that Gold Coast Health Plan and its first-tier, downstream, and related entities consistently operate in accordance with all applicable federal and state laws, regulations, and regulatory guidance.
  • Collaborate with the Government Affairs Department to maintain compliance with CMS, DHCS, and DMHC requirements, including GCHP's Knox Keene license and contractual obligations with regulatory agencies.
  • Work with the Compliance Department, Operations Oversight Department, D-SNP leadership, and other internal stakeholders to address compliance issues, develop corrective action plans (CAPs), and monitor progress towards resolution.
  • Responsible for daily monitoring of CMS's Health Plan Management System (HPMS), required DHCS reporting, DMHC filings, and other required regulatory submissions.
Requirements
  • Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
  • Minimum of 5 years of experience in healthcare compliance, with a focus on Medicare compliance and regulations.
  • Medicare part C and D expertise, including demonstrable knowledge of Medicare regulations, guidelines, audit protocols, and processes.
Preferred Qualifications
  • Master's degree in Healthcare Administration, Business Administration, or a related field.
  • Prior experience with CMS audits (program, timeliness, and data validation) as well as DHCS and DMHC compliance requirements.
  • Broad and detailed knowledge of health plan operations and best practices.
  • Experience with Corporate Integrity Agreements.
What We Offer

Gold Coast Health Plan offers a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and experienced compliance professional looking for a new challenge, we encourage you to apply for this exciting opportunity.



  • Camarillo, California, United States Gold Coast Health Plan Full time

    Job Title: Medicare Compliance ManagerGold Coast Health Plan is seeking a highly skilled Medicare Compliance Manager to join our team. As a key member of our Compliance Department, you will be responsible for developing, implementing, and overseeing the Medicare Compliance Program and initiatives in alignment with our overall D-SNP strategy.Key...


  • Camarillo, California, United States Gold Coast Health Plan Full time

    Job SummaryWe are seeking a highly skilled and experienced Medicare PBM Senior Operations Manager to join our team at Gold Coast Health Plan. This role will be responsible for overseeing the PBM operations and Part D initiatives in alignment with our overall D-SNP strategy.Key ResponsibilitiesLead initiatives related to pharmacy benefits and managing...


  • Camarillo, California, United States Peckham Industries Full time

    About the RoleWe are seeking a highly skilled and experienced Safety and Compliance Manager to join our team at Peckham Industries. As a key member of our organization, you will play a critical role in ensuring the safety and well-being of our employees, customers, and the communities we serve.Key ResponsibilitiesDevelop and Implement Safety Programs:...


  • Camarillo, California, United States GSMS, Incorporated Full time

    Job Title: Regulatory and Compliance SpecialistGSMS, Incorporated is seeking a highly skilled Regulatory and Compliance Specialist to join our team. As a key member of our Quality and Compliance department, you will be responsible for ensuring compliance with regulatory requirements and maintaining accurate records.Key Responsibilities:Maintain accurate...


  • Camarillo, California, United States R&D Transportation Services, Inc. Full time

    Job Title: Incident Compliance SpecialistJob Summary:R&D Transportation Services, Inc. is seeking a highly skilled Incident Compliance Specialist to join our team. As a key member of our Customer Service Department, you will play a critical role in ensuring the highest level of service quality and productivity standards are met.Key...


  • Camarillo, California, United States Top Quality Recruitment (TQR) Full time

    {"title": "Director of Regulatory Compliance and Quality Assurance", "description": "Job SummaryTop Quality Recruitment (TQR) is seeking a highly skilled Director of Regulatory Compliance and Quality Assurance to join our team. As a key member of our organization, you will be responsible for managing, organizing, and maintaining the Quality Assurance and...


  • Camarillo, California, United States Hygiena LLC Full time

    Job SummaryWe are seeking a highly experienced and skilled Senior Global Director of Quality Assurance and Compliance to join our team at Hygiena LLC. This is a critical role that requires a strong leader with a proven track record of driving quality and compliance initiatives across a global organization.Key ResponsibilitiesDevelop and implement quality...

  • Principal Engineer

    1 month ago


    Camarillo, California, United States Hygiena LLC Full time

    Job DescriptionHygiena LLC is a leading provider of rapid microbiology diagnostic tests and solutions for mission-critical, time-sensitive processes around the world. Our proprietary diagnostic technologies enable customers to prevent illness and save lives, comply with regulations, protect products and brands, and run businesses more effectively.We are...


  • Camarillo, California, United States Gold Coast Health Plan Full time

    Job SummaryGold Coast Health Plan is seeking a highly skilled Senior Director, Quality Data to lead our Quality Data program and regulatory operations. This role will provide direction and supervision to the Quality Data team and oversee all aspects of the program, including vendor oversight, technical solutioning, data optimization, and management of...


  • Camarillo, California, United States Gold Coast Health Plan Full time

    Job SummaryGold Coast Health Plan is seeking a highly experienced and innovative Senior Director, Model of Care to lead the development and execution of complex, mission-critical, and enterprise-wide strategic initiatives. This role will focus on advancing the Model of Care, including health programs, benefits, and services, operational improvements, and...

  • MDS Coordinator

    4 weeks ago


    Camarillo, California, United States Full Spectrum Search Group Full time

    Job SummaryFull Spectrum Search Group, a leading healthcare recruiting agency, is seeking an experienced MDS Coordinator to join our team. As a key member of our team, you will be responsible for coordinating the Medicare/MDS resident assessment process and ensuring the Interdisciplinary Team completes the MDS Assessment in a timely...


  • Camarillo, California, United States Full Spectrum Search Group Full time

    Job OverviewRN MDS Coordinator - CCRC - Skilled NursingFull Spectrum Search Group is a premier healthcare recruiting agency focused on long-term care leadership roles, including department heads, regional managers, and executive positions. Our dedicated team of recruiters is committed to connecting exceptional operators with qualified candidates. As part of...


  • Camarillo, California, United States Peckham Industries Full time

    About the RoleWe are seeking a highly skilled and experienced Safety and Compliance Manager to join our team at Peckham Industries. As a key member of our organization, you will play a critical role in ensuring the safety and well-being of our employees, customers, and the communities we serve.Key ResponsibilitiesDevelop and Implement Safety Programs:...

  • Accounting Manager

    2 weeks ago


    Camarillo, California, United States Century Group Full time

    Accounting Manager Opportunity at Century GroupCentury Group is partnering with a client seeking an experienced Accounting Manager to lead their accounting team in Camarillo, CA. The ideal candidate will have a strong background in accounting and finance, with a proven track record of delivering accurate financial results and managing a team of accounting...

  • Production Manager

    4 weeks ago


    Camarillo, California, United States Amtec Direct Hire Full time

    Job SummaryWe are seeking a highly skilled Production Manager to oversee the safe and efficient operation of our manufacturing departments. As a key member of our team, you will be responsible for managing production activities, ensuring quality standards are met, and driving continuous improvement initiatives.Key ResponsibilitiesProduction Planning and...

  • Safety Manager

    2 weeks ago


    Camarillo, California, United States Peckham Industries Full time

    About Peckham IndustriesPeckham Industries is a family-run business with a rich history dating back to 1924. Our company values are built on a foundation of safety, integrity, dedication, and efficiency. We strive to protect our employees, customers, and the environment while delivering high-quality construction materials and services.Job SummaryThe Safety...


  • Camarillo, California, United States WKS Restaurant Group Full time

    Job SummaryWe are seeking a highly skilled and experienced General Manager to lead our Wendy's restaurant team. As a General Manager, you will be responsible for overseeing the day-to-day operations of the restaurant, ensuring exceptional customer service, and driving sales growth.Key ResponsibilitiesManage sales goals versus budget and prior year, executing...


  • Camarillo, California, United States Century Group Full time

    Assistant Controller Job DescriptionCentury Group is partnering with a client seeking an experienced Assistant Controller to lead financial reporting and analysis efforts.Key Responsibilities:Prepare and review monthly, quarterly, and annual financial statements to ensure accuracy and compliance.Collaborate with the Controller and Finance team to analyze...

  • Practice Manager

    3 weeks ago


    Camarillo, California, United States 10046 Sound Inpatient Phys Inc (SIP) Full time

    About the RoleWe are seeking a highly skilled Practice Manager to join our team at 10046 Sound Inpatient Phys Inc (SIP). As a Practice Manager, you will play a critical role in the on-site operational management and support of our physician practice.Key ResponsibilitiesAct as the front-line liaison for the provider team with hospital C-Suite, nursing...


  • Camarillo, California, United States The Wendy's Company Full time

    Job SummaryWe are seeking a highly skilled and experienced Assistant General Manager to join our team at The Wendy's Company. As a key member of our restaurant management team, you will be responsible for assisting the General Manager in managing the day-to-day operations of our restaurant, including supervising staff, managing inventory, and ensuring...