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Compliance Manager

Job Summary: The Manager of Compliance is responsible for managing and improving the Prominence Health Plan Compliance Program to assure compliance with State and Federal regulations for health plan products including Medicare Parts C and D, large- and small-group health plans, third-party administration, and other commercial health plan products. The Manager of Compliance assists the Director of Compliance with oversight of the compliance and regulatory matters and is primarily responsible for overseeing the organization’s operational areas. This position serves as an internal consultant to management and staff regarding compliance with Federal and State laws and regulations (Centers for Medicare and Medicaid Services, Nevada Division of Insurance, Texas Department of Insurance) contract provisions, accreditation standards, and internal policies and procedures. The Compliance Manager will implement plan-wide initiatives, policies and processes related to the Compliance Program and be responsible for program implementation, risk assessment, reports creation, communications, education and training, auditing and monitoring, and corrective action planning. This position Education:
• Bachelor’s degree in business administration, healthcare administration, public administration or other related field; Master’s degree preferred. Relevant experience may be substituted for educational requirements for exceptional candidates.
• Certified in Healthcare Compliance (CHC) preferred.
• Minimum five years’ experience in health insurance or health care.
• Minimum two years’ demonstrated successful experience in compliance, quality assurance, administrative and/or operational duties in health care, preferably in a management role in a managed care organization.
reports to the Director of Compliance.

Time:  Full time
Salary:  Salary
Category:  Compliance

Updated: 11/23/2020 9:09:49 PM

Job Contact:
Edita Gates

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1510 Meadow Wood Ln
Reno, NV 89502