• Medicare Compliance Manager (Medicare Advantage…

    Molina Healthcare (ID)


    Job Description

    Job Summary

    Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.

    Knowledge/Skills/Abilities

    • Assists with implementation and day-to-day operations of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud, Waste and Abuse Plan across the enterprise while ensuring compliance with governmental requirements.

    • Spearheads development and implementation of compliance policies and procedures and training programs for the Molina enterprise.

    • Oversees and provides direction of site visits for regulatory audits and coordinates corrective action plan, as needed.

    • Investigates and resolves compliance problems, questions, or complaints received internally or from customers/agencies.

    • Provides input and representation on key compliance initiatives, meetings, and committees. Stays abreast of industry and compliance trends; recommends and implements changes to internal company processes as needed..

    Job Qualifications

    Required Education

    Bachelor's Degree or equivalent combination of education and experience

    Required Experience

    5-7 years

    Preferred Education

    Masters Degree preferred; will consider previous experience in health plan setting in government programs management (Contract Manager)

    Preferred Experience

    7-9 years

     

    To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

     

    Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

    Pay Range: $77,969 - $155,508 / ANNUAL

    *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.