Risk Management and Compliance Expert
7 days ago
The Manager of Compliance and Risk Management is a critical position at Foundations for Living, responsible for overseeing and improving the organization's Compliance and Risk Management Program. This program ensures compliance with State and Federal regulations for health plan products, including Medicare Parts C and D, large- and small-group health plans, third-party administration, and other commercial health plan products.
Key Responsibilities- Manage and improve the Compliance and Risk Management Program to ensure compliance with State and Federal regulations.
- Assist the VP, Compliance & Risk Management with oversight of compliance and regulatory matters.
- Oversee the organization's operational areas and serve as an internal consultant to management and staff regarding compliance with Federal and State laws and regulations.
- Implement plan-wide initiatives, policies, and processes related to the Compliance and Risk Management Program.
- Be responsible for program implementation, risk assessment, incident reporting, reports creation, communications, education and training, auditing and monitoring, and corrective action planning.
- Bachelor's degree in business administration, healthcare administration, public administration, public health, or other related field required; Master's degree preferred.
- Minimum five years' experience in health insurance or healthcare.
- Minimum two years' demonstrated successful experience and increasing responsibility in compliance, quality improvement, risk management, administrative, and/or operational duties in healthcare, preferably in a management role in a managed care organization.
- Experience with the U.S. DHHS Office of Inspector General compliance program guidelines, State and Federal laws, regulations, policies, and practices for the administration of Medicare Advantage, Prescription Drug Plan, and compliance programs in a managed care organization.
- Experience with risk management and quality improvement methodologies to comply with Chapter 641.5, Florida Statutes, and Chapter 59A-12.012, Florida Administrative Code.
- Ability to effectively communicate in English, both verbally and in writing.
- Excellent computer skills, including MS Word, Excel, and PowerPoint proficiency.
- Independent judgment and critical thinking skills required.
Foundations for Living is a value-based care organization that bridges the gap between affiliated health systems and independent providers, building trust and collaboration between the two. We create value for populations and providers to strengthen integrated partnerships, advance market opportunities, and improve outcomes for our patients and members.
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Risk Management and Compliance Expert
7 days ago
Reno, Nevada, United States Foundations for Living Full timeAbout the RoleThe Manager of Compliance and Risk Management is a critical position within Foundations for Living, responsible for overseeing and improving the organization's Compliance and Risk Management Program. This program ensures adherence to State and Federal regulations, including those related to Medicare Parts C and D, large- and small-group health...
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Compliance and Risk Management Professional
7 days ago
Reno, Nevada, United States Foundations for Living Full timeAbout the RoleThe Manager of Compliance and Risk Management is a critical position within Foundations for Living, responsible for overseeing and improving the organization's Compliance and Risk Management Program. This program ensures adherence to State and Federal regulations for health plan products, including Medicare Parts C and D, large- and small-group...
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