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Company

CareSource · 3 hours ago

REMOTE - Arkansas PASSE Manager, Compliance (Must live in Arkansas) - R8251

United States

Full-time

Remote

Mid, Senior Level

$81K/yr - $143K/yr

5+ years exp

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Responsibilities

Serves as the CareSource Arkansas PASSE compliance officer

Serves on the AR leadership team with matrixed reporting to the market

Serve as the primary point of contact with state regulators for all PASSE compliance issues, build goodwill and trust with regulators

Ensures and oversees that regulatory requirements impacting products offered in Arkansas are tracked and implemented in a timely manner utilizing the process and forms prescribed by the corporate Compliance team

Align, oversee, and maintain Arkansas compliance and regulatory operations in accordance with agreed upon best practices and corporate standards. Actively participate in Corporate Compliance hosted meetings to identify and implement best practices and templates

Accountable for drafting at least quarterly status reports for the Corporate Compliance Officer and/or Audit Committee of the Board

Partner with Business Units and internal support functions to help ensure that all compliance requirements have been met; risk is monitored and remediated through testing/ development/ implementation and use

Provide review and input on proposed laws. Remain current in federal/state laws and regulations regarding Medicaid requirements as applicable as well as general compliance and delegation oversight best practices and industry standards

Assist with the creation and execution of the annual compliance work plan, risk assessment activities

Assist in management of applicable compliance oversight functions such as Corrective Action Plan Management, Ongoing Monitoring, and Annual Audits

Report key statistics and trends of core compliance and oversight functions, identifying risk mitigation and performance improvement opportunities to the Delegation Oversight and Compliance Committees as well as to Compliance and Company Leadership

Perform data analysis and reporting activities. Provide and maintain oversight reporting mechanisms, and track and report outcomes from compliance activities. Collect, organize, and distribute reports and documents and recommend enhancements to reporting compliance tools

Track and trend issues to identify compliance risk and performance improvement opportunities; provide input for executive compliance reporting

Assist with regulatory audits, in collaboration with the Caresource external audit team, EQRO regulatory audits and site visits.

Establish effective working relationships and build creditability within the organization to support a culture of compliance based on the Company's core values

Report potential risks, non-compliance or alleged violations to Compliance leadership and plan leadership

Perform any other job duties as requested

Qualification

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Healthcare CompliancePASSE ExperienceMedicaid Managed CareMicrosoft WordMicrosoft ExcelMicrosoft PowerPointCustomer Service Orientation

Required

Bachelor of Science/Arts degree or equivalent years of relevant work experience is required

Minimum of five (5) years of healthcare compliance, vendor oversight, internal audit or equivalent experience is required

PASSE or Medicaid Managed Care experience is required

Advanced capabilities in Microsoft Word, Excel and PowerPoint

Skilled in collaborative management of professional staff

Knowledge of contracting, standards or controls management, preferably from a Managed Care Organization

Knowledge of Medicaid, Federal Marketplace and Medicare Regulatory environment as applicable

Proven success in developing and implementing new practices and controls (with specific improvements)

Experience in a high-growth business environment

Strong analytical and statistical skills and attention to detail

Ability to work in a fast-past environment and reprioritize

Effective problem solving skills with attention to detail

Ability to develop, prioritize and accomplish goals

Strong communication skills (both written and verbal)

Strong interpersonal skills & high level of professionalism

Ability to work independently and within a team environment

Effective active listening and critical thinking skills

Display a customer service, member-focused orientation

Preferred

Prior management experience is preferred

Established relationships with the Arkansas Department of Human Services (DHS), Centers for Medicare & Medicaid Services (CMS), state Departments of Insurance and/ or state Medicaid Departments is preferred

Working knowledge of health plan environment is preferred