Senior Manager, Compliance – Health Plan/MCO Experience

CareSource

. Provide compliance oversight and organizational leadership related to compliance .

Posted 11/9/2026full-timeRemote • United StatesSenior💰 $94,100 - $164,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in healthcare compliance, particularly within Marketplace, Medicare, and Medicaid environments, while effectively managing compliance teams and regulatory relationships. Proficient in developing compliance training programs and overseeing compliance activities to ensure adherence to federal and state regulations.

Highest-signal resume keywords

Healthcare Compliance ExperienceMarketplace, Medicare, Medicaid ExpertiseTeam Leadership and ManagementRegulatory Relationship ManagementCompliance Training Development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Compliance OversightRegulatory AuditsInquiry ManagementComplaint ManagementData Reporting DesignRisk AssessmentPolicy DevelopmentRegulatory DistributionPerformance ManagementStrategic Decision-Making

Soft Skills

Excellent Problem SolvingCritical ThinkingEffective CommunicationAttention to DetailTime Management

Tools & Technologies

Microsoft Office SuiteWordExcelOutlookPowerPointSharePointVisio

Industry Keywords

Managed Care PrinciplesBenefit DesignClaims ProcessingCompliance PracticesFederal and State RegulationsCompliance Workplan ExecutionCompliance Incident ResponseRegulatory GuidebooksCompliance CommitteesHealthcare Compliance Standards

About the role

Key responsibilities & impact

Provide compliance oversight and organizational leadership related to compliance
Proactively collaborate with partners and provide insights from analyses
Lead a team developing and maintaining State and Federal Regulatory Guidebooks, job aids, tools, and resources
Serve as a compliance leader in the Marketplace, Medicare, and Medicaid arena
Manage Federal and State regulator relationships and oversee regulator meeting agendas, execution, and follow-up
Oversee compliance activities, including inquiry management, complaint management, regulatory distribution, and compliance workplan execution
Lead Marketplace, Medicare, and Medicaid Compliance Committees and workgroups
Oversee policies, procedures, and standard operating procedures for regulatory, statutory, corporate, and contractual compliance
Monitor Federal and State laws, regulations, compliance practices, and industry standards
Provide risk feedback to Compliance leadership for annual compliance risk assessments
Assist with compliance workplan execution, regulatory audits, audit readiness, and reporting validation
Respond to compliance incidents and oversee reporting, communication, corrective actions, and remediation
Oversee compliance activity tracking and reporting to internal and external stakeholders
Support escalated external-entity issues and develop training programs to address compliance knowledge gaps
Provide compliance training to internal and external stakeholders
Collaborate with Market and Corporate leadership and business departments on compliance program management
Maintain relationships with State and Federal regulators
Provide subject matter expertise for market and enterprise initiatives
Keep leadership informed of regulatory initiatives, compliance concerns, operational issues, corrective actions, and remediations
Develop, recruit, retain, and manage compliance staff
Supervise staff, provide performance management feedback, and address disciplinary issues
Train current and new staff and develop training materials
Keep management apprised of team performance, projects, and issues
Perform other duties as requested

Requirements

What you’ll need

Bachelor of Science/Arts degree or equivalent years of relevant work experience is required
Minimum of seven (7) years of healthcare compliance, managed care experience, vendor oversight, internal audit or equivalent experience is required
Minimum of three (3) years direct management experience required
Specific Marketplace, Medicare and Medicaid managed care experience is required as applicable for the Senior Manager’s product oversight
Strong health plan/MCO compliance and AI experience preferred
Proficient in Microsoft Office Suite to include Word, Excel, Outlook, PowerPoint, SharePoint, and Visio
Knowledge of managed care principles, benefit design, claims processing, finance, data reporting design, and analysis
Familiarity with the managed care concepts, practices and procedures
Develops and maintains an expert knowledge of the company’s business and regulatory environments
Excellent problem solving and critical thinking skills
Effectively communicate in a matrix environment with excellent verbal, written, and presentation skills
Strong attention to detail
Excellent organization and time management skills
Ability to develop, prioritize and accomplish multiple goals
Strategic thinking and decision-making skills
Required to travel to market office(s) on occasion
No licensure or certification required

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Total well-being support