Job Summary:
The Manager, Compliance is responsible for is responsible for ensuring and documenting CareSource AR and CareSource PASSE have an effective ethics and compliance program. To include, supporting the establishment of a baseline compliance risk, identification of areas of potential exposure, development and alignment of compliance risk management strategies with CareSource goals and objectives, and execution of the compliance program ensuring consistency.
Essential Functions:
- 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
Education and Experience:
- 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
- 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
Competencies, Knowledge and Skills:
- 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
- Working knowledge of health plan environment is preferred
- 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
Licensure and Certification:
Working Conditions:
- Ability to travel to Little Rock, Arkansas office when required
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$81,450.00 - $142,560.00
CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
