.JOB SUMMARY: Responsible for overseeing all ongoing compliance activities related to the development, implementation, maintenance of, and adherence to Community Health Choice (Community) policies and procedures covering Medicare Advantage, Medicare-Medicaid Plan (MMP) and Dual Eligible Special Needs Plans (D-SNPs) and Health Insurance Marketplace plans. Organizes, directs and ensures the compliance of Medicare Advantage, MMP, D- SNP and Health Insurance Marketplace plans and plan managed care programs with all applicable State and Federal Regulatory bodies.
MINIMUM QUALIFICATIONS:
- Education/Specialized Training/Licensure: BA/BS degree required
- Certification in Healthcare Compliance (CHC) preferred
- Work Experience (Years and Area): 7 years experience in a managed care organization. Knowledge of and compliance experience in Medicare Advantage, MMP and D-SNP and Health Insurance Marketplace
- Management Experience (Years and Area): 4 years management experience in a healthcare setting
- Software Operated: Microsoft Office (Word, Excel, Outlook)