Compliance Manager

Compliance Manager

The Compliance & Integrity Manager provides leadership, oversight, and operational direction for assigned compliance and program integrity functions. This role ensures adherence to regulatory, contractual, accreditation, and organizational requirements through effective monitoring, auditing, risk assessment, corrective action management, and continuous improvement activities. The position supervises compliance staff while independently leading complex compliance initiatives, investigations, readiness activities, and organizational risk mitigation effort.

Estimated Hiring Range:
$113,940.00 - $139,260.00

Bonus Target:
Bonus - SIP Target, 5% Annual

Priority will be given to candidates residing in Oregon and Southwest Washington.

Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Essential Responsibilities

Program Leadership & Oversite

• Provide strategic leadership, oversight, and continuous improvement for one or more assigned compliance programs.
• Develop program goals, workplans, performance measures, reporting mechanisms, policies, procedures, and controls.
• Leverage data analytics, performance metrics, and trend analysis to identify emerging risks, evaluate program effectiveness, prioritize resources, and support strategic decision-making.
• Oversee monitoring, auditing, oversight, readiness, corrective action, investigation, and reporting activities as applicable to assigned programs.
• Identify and escalate compliance, operational, strategic, financial, and reputational risks.
• Ensure assigned programs maintain appropriate policies, procedures, controls, documentation, reporting, and monitoring activities.
• Serve as a subject matter expert for assigned compliance programs.
• Directly perform complex compliance, oversight, monitoring, auditing, readiness, and program integrity activities.
• Lead strategic initiatives, assessments, investigations, and reviews.
• Balance direct program execution responsibilities with workforce leadership and development.

Employee Supervision

• Manage team and recommend team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensure team adheres to department and organizational standards, policies, and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 5 years of experience of progressive experience in Medicare, Medicaid, Managed Care, Compliance, Regulatory Affairs, Audit, Program Integrity, Delegation Oversight, Risk Management, Healthcare Administration, or related functions.
• Minimum three (3) years of experience facilitating, implementing, overseeing, or managing regulatory, contractual, compliance, audit, monitoring, oversight, readiness, corrective action, or risk management activities.
• Minimum two (2) years of workforce leadership experience or demonstrated success leading complex cross-functional initiatives requiring influence without direct authority.
• Experience interacting with federal and/or state regulatory agencies, auditors, accreditation organizations, delegated entities, or oversight bodies.
• Experience using analytics, reporting, workflow, or other technology tools to support compliance oversight, program execution, decision-making, and continuous improvement.

Preferred

• Minimum 2 years' experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon's Aspiring Leaders Program
• Bachelor's degree in business, Health Care Administration, Analytics, Public Administration, or related discipline.
• Experience supporting CMS, OHA, NCQA, URAC, Health Share, or other regulatory and accreditation activities.
• Experience presenting information to executive leadership, governance committees, or boards.

Knowledge, Skills and Abilities Required

Knowledge

• Strong knowledge of state and federal compliance plan requirements for Medicare and Medicaid Programs including the Oregon CCO contract and all applicable CMS online manual chapters
• Proficient knowledge of OAR's, CFRs, sub-regulatory guidance, and their purpose
• Understanding of CMS related managed healthcare operations
• Understanding of contract law and maintenance of policies and procedures related to contracts entered into by corporate officers
• Working knowledge of the Patient Protection and Affordable Care Act
• Solid understanding of information systems
• Understanding of how the functions of a business work and relate to one another to benefit the member by improving regulatory compliance

Skills and Abilities

• Strong interpersonal and motivational skills
• Excellent written and verbal communication skills
• Investigative and problem solving skills
• People leadership skills, including the ability to manage and coach team members
• Ability to perform or oversee the performance of risk assessments and/or gap analysis
• Ability to manage and facilitate learning opportunities in a variety of informal and formal settings
• Ability to make presentations to small and large groups
• Ability to think logically and creatively without undue influence from personal biases
• Ability to build conceptual models and communicate complex ideas effectively
• Ability to plan, organize, manage, and monitor work projects
• Ability to serve in an internal consulting role, assisting the organization's management and staff in embracing our goal of "doing it right the first time" and being cognizant of the company's commitments to its various partners and the need to achieve excellent results in our work product and processes
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): ☒ Indoor/Office • Community • Facilities/Security • Outdoor Exposure

Member/Patient Facing: ☒ No • Telephonic • In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.