51 applicants

Company

Original Job Post

Progyny, Inc. · 1 week ago

Compliance Manager

United States

Full-time

Remote

Senior Level

$90K/yr - $105K/yr

10+ years exp

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Comp. & Benefits

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Responsibilities

Develop and maintain all compliance policies associated with accreditations.

Coordinate all facets of the URAC and NCQA accreditation and reaccreditation process.

Assist in training in current NCQA and URAC standards.

Implement compliance programs, policies, and procedures.

Analyze delegation audit results and make recommendations for improvement.

Identify and communicate with appropriate departments, teams, and key leadership on internal audit results and deficiencies.

Prepare audit files for submission as required.

Participate in delegation audits and external audits.

Coordinate with delegated partners to ensure adherence to regulations.

Follow up on corrective action plans ensuring timely closure.

Prepare adverse determination notices in compliance with regulatory requirements.

Demonstrate proficiency in the application of health plan/employer group guidelines.

Review and adhere to department policies and the Utilization Management plan.

Conduct standard random audits and focused audits.

Supervise the licensing and credentialing function.

Perform other duties as assigned.

Qualification

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Healthcare legal operationsCompliance policy developmentAuditNCQAURACHIPAARegulatory compliancePolicy developmentStakeholder managementFast-growing organization experienceProblem-solvingJudgmentProject managementClient relationship managementConsultationPresentation

Required

Clinical degree, Bachelor’s or Master’s degree in a related field

Minimum of 10 years in healthcare legal operations, healthcare project management, internal audit or healthcare compliance

Minimum of 8 years of compliance policy development, audit, and maintenance with a strength in NCQA, URAC, and HIPAA

Proven track record of working with external regulatory and compliance partners for client relationship management and consultation within healthcare

Excellent messaging, positioning, and presentation of policy to internal and external stakeholders

Unparalleled project management skills - identify a goal and the steps needed; actively manage action steps to accomplish goal while managing and holding key stakeholders accountable

Strong compliance acumen; strong problem-solving, judgment and analytic skills

Prior experience and success in a fast-growing organization

Benefits

Paid family and parental leave

Fertility and family building benefits (including egg freezing, IVF, and adoption support)

Family care fund and Parents’ Employee Resource Group

Health, dental, vision, and life insurance options for employees and family

Free in-person, virtual, and text-based mental health and wellness support

Paid time off, including vacation, sick leave, personal days, and summer flex time

Company equity

Bonus program

401(k) plan with company match

Access to on-demand legal and financial advice

Company social events

Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office

Company

Progyny, Inc.

Glassdoor

3.8

Progyny is a transformative fertility, family building, and women's health benefits solution, trusted by the nation's leading employers, health plans and benefit purchasers.

Founded in 2008

New York, New York, USA

201-500 employees