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Compliance Program Manager III, Government Products Precertification Lead

2 months ago

Canton, Ohio, United States Point32Health, Inc. Full time
About the Role

Point32Health, Inc. is seeking a highly skilled Compliance Program Manager III to join our team. As a key member of our compliance department, you will be responsible for developing, implementing, and maintaining our comprehensive compliance program for Medicaid products.

Key Responsibilities
  • Compliance Program Management
    • Develop and implement a comprehensive compliance program that includes performance auditing, monitoring, and reporting.
    • Identify and propose strategies to mitigate compliance risks.
    • Directly administer activities, projects, and personnel necessary to ensure compliance with Medicaid laws and regulations.
  • New Regulatory Guidance
    • Research and disseminate new regulatory guidance.
    • Lead the department team to evaluate guidance, prepare a gap analysis, and ensure timely implementation and alignment with department operations.
  • Audits, Monitoring, and Reporting
    • Create an "audit ready" department culture.
    • Collaborate with department senior manager, team managers, corporate compliance, and other departments to coordinate internal and external audit activities and internal monitoring and reporting activities.
  • Leadership and Collaboration
    • Manage direct reports, both clinicians and non-clinicians as needed.
    • Lead and/or represent the department at cross-functional meetings and interdepartmental meetings as necessary.
Requirements
  • Education
    • Bachelor's degree in a clinical or healthcare-related area required.
  • Experience
    • 5-8 years of related experience in a managed healthcare environment, with 3-5 years of clinical compliance project/program management and operational management experience.
    • 8-10 years of progressive business experience.
    • 3-5 years of Medicaid product utilization management experience required.
    • Medicaid compliance experience preferred.
  • Skills
    • Results orientation.
    • Highly developed critical and analytic thinking.
    • Proven ability to integrate compliance requirements into utilization review operations and clinical system documentation.
    • Influencing others.
    • Strong communications skills.
    • Coaching and mentoring.
    • Commitment to excellence in customer service.
    • Ability to develop creative strategies to address problems and overcome obstacles in a rapidly changing, highly regulated environment.
    • Excellent project management/program management skills.
What We Offer

As a valued member of our team, you will receive a comprehensive total rewards package, including:

  • Medical, dental, and vision coverage.
  • Retirement plans.
  • Paid time off.
  • Employer-paid life and disability insurance with additional buy-up coverage options.
  • Tuition program.
  • Well-being benefits.
  • A full suite of benefits to support career development, individual and family health, and financial health.