Senior Manager, Ethics & Compliance

5 - 7 years experience  •  Healthcare IT

Salary depends on experience
Posted on 09/21/17
Rancho Cordova, CA
5 - 7 years experience
Healthcare IT
Salary depends on experience
Posted on 09/21/17


 Position Purpose: Manage and implement strategies to ensure successful maintenance and implementation of compliance programs that meet regulatory requirements for assigned products across the entire company

  • Ensure all Medicare and Medicaid product and services are being tested for compliance with program regulations, insurance regulations, and regulatory requirements for business entities
  • Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures
  • Develop policies, procedures, and process to comply with federal program regulations, and any applicable state regulations
  • Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contractlanguage
  • Conduct compliance audits, develop and implement corrective action plans
  • Perform planrisk assessments and report emerging trends, deficiencies and variances; report findings to other departments and teams as appropriate
  • Provide required Ethics, Compliance, Risk Management, FWA, privacy, and security training for existing and new employees and as required non-employees
  • Provide mentoring and guidance to subordinates within the department as necessary
  • Serve as primary backup to department lead as necessary
    Commercial Insurance (additional responsibilities):
  • Monitor Commercial product risks in accordance with the riskreporting policies
  • Manage Benefit Filings and entity licensures for all products to ensure compliance with state and federal regulatory requirements
  • Work in collaboration with Marketing teams to monitor Sales & Marketing representatives and materials used in advertisements
    Medicare (additional responsibilities):
  • Monitor the FDR oversight program to ensure all Medicare and MMP plans are conducting the appropriate oversight in a timely manner
  • Report all Medicare and Medicaid product risks in accordance with the riskreporting policies
  • Partner with various departments as the local executive responsible for ensuring that state and/or federal regulatory requirements relating to business continuity and disaster recovery are communicated and met


Knowledge/Experience: Bachelors’ degree in related field or equivalent experience. Master's or Juris Doctorate degree preferred. 5+ years of compliance experience, preferably in a healthcare environment with at least 3+ years of Medicaid, Medicare or Commercial Managed Care experience. Previous experience demonstrating effective interaction with federal and state regulatory agencies in a managed care or insurance environment preferred.


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