Compliance Consultant, MAPD Vendor Management

We are seeking a highly experienced Compliance Consultant to
provide expert-level support in the development, implementation, and ongoing
maintenance of our Medicare Advantage Vendor Management Program ("Program").
This position is crucial for ensuring that the organization remains in full
compliance with CMS, DMHC, and other regulatory bodies, while also supporting
the viability of new product offerings through vendor oversight. The ideal
candidate will possess a deep working knowledge of CMS and DMHC regulatory
requirements and industry best practices as they relate to Medicare Advantage
health plan operations.

Key Responsibilities:

• Serve as a subject matter expert to guide internal
  and external stakeholders (i.e., vendors, FDRs) in maintaining regulatory
  compliance with CMS, DMHC, and other applicable healthcare regulations and
  settings.
• Collaborate with cross-functional teams to develop,
  implement, and maintain Program procedures tailored to the organization's
  structure, operations, and product offerings.
• Provide day-to-day support for the execution of the
  Program's compliance elements to ensure ongoing adherence with regulatory
  standards and enhance operational efficiency.
• Analyze the Program's compliance practices and
  identify areas for improvement or modification based on regulatory changes
  or industry best practices.
• Effectively communicate compliance requirements and
  strategies across various levels of the organization.
• Monitor
  regulatory data submissions from all data contributors and conduct timely
  reviews of actionable system tasks.
• Assess and document potential compliance risks and
  provide actionable recommendations to mitigate these risks.
• Lead and support compliance training initiatives for
  staff and business partners, ensuring a strong understanding of relevant system
  operations, regulations and Program procedures.
• Collaborate with key stakeholders to ensure that all
  compliance requirements are integrated into business processes and
  operational workflows.
• Stay current with changes in relevant laws,
  regulations, and best practices to ensure the Program and organization's
  compliance efforts remain up-to-date.

We're seeking a detail-oriented, self-directed individual
with:

• Bachelor's Degree or five (5) years of Medicare
  Compliance experience at a health plan in lieu of a degree
• Minimum of 3 years of previous experience in a
  compliance or vendor oversight role
• Experience with Medicare Advantage health plan,
  particularly in an integrated system, is highly desired
• Strong working knowledge of CMS regulations,
  audits, expectations, and best practices
• Experience interacting with regulatory agencies
  and/or auditors to ensure compliance and address audit findings or inquiries