DescriptionWe are seeking an experienced Compliance Consultant to support the ongoing administration and enhancement of the Plan's Medicare Advantage Vendor Management Program. This role helps ensure compliance with CMS, DMHC, and other applicable regulatory requirements while strengthening vendor oversight, supporting operational effectiveness, and contributing to the successful development of new products and expanded services.
In this role, you will:
- Coordinate vendor onboarding, classification, delegation assessments, contract management and ongoing oversight activities.
- Review and maintain vendor documentation, contracts, inventories, compliance records, and related materials.
- Monitor vendor and First-Tier, Downstream, and Related Entity (FDR) performance, identify potential risks, and support corrective actions and process improvements.
- Ensure compliance with Medicare Advantage, CMS, DMHC, contractual, and organizational requirements.
- Support the development, maintenance, and annual review of policies, procedures, and operational guidance.
- Prepare and maintain regulatory, compliance, and operational reports, metrics, and supporting documentation.
- Support internal and external audits, regulatory inquiries, and ongoing audit-readiness activities.
- Investigate, document, and escalate potential compliance issues, incidents, and risks as appropriate.
- Coordinate governance activities, including preparing committee materials and presentations, documenting meeting minutes, and tracking action items.
- Maintain vendor management systems, SharePoint resources, and vendor-facing compliance materials, escalating when appropriate to remediate.
- Provide guidance, training, and ongoing support to vendors, Vendor Relationship Owners (VROs), Accountable Owners (AOs), and other stakeholders.
- Participate in special projects and initiatives supporting vendor management, compliance program objectives, system enhancements, regulatory requirements, new product offerings, service expansion, and operational improvements.
Salary Range: $88,900 - $190,300/annually
