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Director, Compliance – Preferred Experience in Health Plan Operations
CareSource. Establish baseline compliance risk and identify potential exposure areas .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in compliance risk management, regulatory oversight, and health plan operations, with a strong ability to lead cross-functional teams and implement compliance programs effectively.
Highest-signal resume keywords
Compliance Risk ManagementHealth Plan OperationsRegulatory OversightData AnalysisRelationship Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Compliance Program DevelopmentFederal/State Law InterpretationAudit ManagementRisk AssessmentCompliance Tracking ToolsPerformance ImprovementCorrective Action PlansData AnalysisCompliance ReportingRegulatory Guidance
Soft Skills
LeadershipCommunicationProblem-SolvingCollaborationAttention to Detail
Tools & Technologies
MS Office SuiteCompliance Tracking Tools
Certifications & Qualifications
Certified in Healthcare Compliance (CHC)
Industry Keywords
MedicaidMedicareMarketplaceCMSHHSDOIHealth Plan EnvironmentRegulatory ComplianceHealthcare AdministrationCompliance Risk
About the role
Key responsibilities & impact- Establish baseline compliance risk and identify potential exposure areas
- Develop and align compliance risk management strategies with CareSource goals and objectives
- Execute and maintain effective compliance programs for assigned CareSource programs
- Serve as program compliance officer and maintain relationships with relevant regulatory entities
- Assist the Chief Compliance Officer with implementation of compliance programs
- Oversee regulatory guidance, regulator requests, audit deliverables, investigations, and implementation of required changes
- Partner with business units and internal support functions to monitor, test, remediate, and implement compliance requirements
- Interpret and implement federal/state laws and regulations regarding Medicaid, Medicare, Marketplace, general compliance, and delegation oversight
- Contribute to annual compliance work plans and risk assessments
- Manage compliance tracking tools and data
- Oversee corrective action plans, ongoing monitoring, and annual audits
- Develop reporting on compliance statistics, trends, risk mitigation, and performance improvement opportunities
- Perform data analysis and maintain compliance oversight reporting mechanisms
- Track and trend issues and provide input for executive compliance reporting
- Assist with regulatory audits and drive audit readiness
- Prepare audit responses and oversee corrective actions
- Collaborate on compliance alerts, newsletters, and educational materials
- Report potential risks, non-compliance, and alleged violations to leadership
- Coordinate with business, regulatory, and legal teams on laws, regulations, guidance, contracts, and corrective actions
- Provide management and oversight of professional staff
- Partner with the Corporate Privacy Officer on HIPAA Privacy compliance
- Perform other requested duties
Requirements
What you’ll need- Bachelor’s Degree in Business/Healthcare Administration or a related discipline, or equivalent years of relevant work experience are required
- Minimum of five (5) years of relevant work experience within health plan operations required
- Three (3) years of management experience required
- Centers for Medicare & Medicaid program experience, State Medicaid Agency program experience or qualified health plan (marketplace) experience required
- Advanced capabilities in MS Office suite including Microsoft Word, Excel and PowerPoint
- Ability to motivate, influence, and lead matrixed and cross-functional teams
- Strong relationship management, communication, analysis, collaboration, problem-solving, and attention-to-detail skills
- Ability to interpret and implement federal/state laws and regulations regarding Medicaid, Medicare and Marketplace requirements
- Knowledge of regulatory environment and regulators (CMS/HHS/DOI/Medicaid)
- Experience in a high-growth business environment
- Ability to work in a fast-paced environment and accomplish goals
- MBA, Juris Doctorate or other advanced degree preferred
- Working knowledge of health plan environment preferred
- Certified in Healthcare Compliance (CHC) preferred
Benefits
Comp & perks- Bonus tied to company and individual performance may be available
- Substantial and comprehensive total rewards package
- Employee total well-being support