Manager, Medicare Advantage Compliance- Peak Health

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The Manager, Insurance Compliance will be integral to the success of Peak Health’s Compliance Department. The Manager, Insurance Compliance is responsible for the implementation of First-tier, Downstream, and Related Entities (FDRs) vendor governance and will ensure transparent and effective controls are implemented in alignment with risk management and compliance best practices. The Manager will serve as an advocate for FDR oversight and influence operational practices across Peak Health. This role will drive the development of enhancements to new or existing policies, procedures, controls, and programming. This individual will work independently, as well as in collaboration with key stakeholders (i.e., Information Security, Finance, Legal, Peak Operational Departments) from across the organization.

The Manager will report to the Director, Insurance Compliance, as part of a fast-paced team developing compliance programming and program integrity plans to support Peak Health’s strategic initiatives. This role also requires utilization of regulatory or compliance experience, to synthesize critical regulatory information to identify issues, barriers, or risks, and develop solutions. Other responsibilities include providing thought leadership across multiple functions to facilitate effective decision-making, enable execution, maximize organization effectiveness, and deliver reporting tailored to appropriate stakeholder audiences.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s Degree in healthcare administration, business administration, or related field

EXPERIENCE:

1. Four (4) years of experience in health care compliance

2. Two (2) years of experience in FDR compliance

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Advanced Degree, or equivalent work experience in lieu of

2. Certified in Healthcare Compliance (CHC) or industry equivalent

EXPERIENCE:

1. 3+ years vendor or Vendor Management experience

2. Consulting experience in program implementation in the healthcare industry preferred.

3. Strong written and oral communication skills, with the ability to communicate complex information at all levels of the organization

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Build and implement FDR oversight program including operationalization of third-party engagements and the associated program-level compliance activities to support effective vendor and FDR compliance across Peak Health.

2. Monitor and evaluate the adequacy and effectiveness of the various inter-dependent compliance and related program policies, procedures, processes, systems, and internal controls that will help effectively manage FDR oversight.

3. Review, design, and implement program risk reporting, analytics, and metrics that accurately measure and represent third-party related risk, including the definition of risk appetite, key risk indicators, risk aggregation, and quantification models.

4. Continuously refine and adapt the FDR oversight program in response to emerging trends, evolving industry best practices, and regulatory requirements.

5. Must be an effective change agent and collaborator, possess the skills and willingness to perform duties that are a combination of tactical, transactional, and strategic in nature.

6. Drive regulatory research to support operational objectives, consulting with business SMEs to define the issue and coordinate appropriate regulatory research.

7. Collaborate with leadership on strategy development, working with business partners to ensure appropriate actions taken to prioritize and implement initiatives.

8. Enhance and drive the maturity of the Peak Health Compliance Plan to deliver optimum customer value and employee engagement.

9. Facilitate strategic conversations to assess and determine regulatory requirements for their operational impacts and solutions. Lead and support the identification, removal, or escalation of barriers.

10. Lead and participate in internal compliance programs and projects to ensure scope, timing, and budget are defined, communicated, and executed with appropriate change control