Hearst Health
Join to apply for the
Compliance Manager
role at
Hearst Health 1 week ago Be among the first 25 applicants Join to apply for the
Compliance Manager
role at
Hearst Health Job Description
All potential candidates should read through the following details of this job with care before making an application.
The Compliance Manager will perform a range of duties including, but not limited to, evaluating all current and new compliance regulations, reviewing company policies and procedures, provide subject matter expertise and performing internal audits. The successful candidate will be able to multi-task and be an excellent communicator, with in-depth knowledge of the latest industry trends and regulations. Job Description
The Compliance Manager will perform a range of duties including, but not limited to, evaluating all current and new compliance regulations, reviewing company policies and procedures, provide subject matter expertise and performing internal audits. The successful candidate will be able to multi-task and be an excellent communicator, with in-depth knowledge of the latest industry trends and regulations.
Key Responsibilities:
Thought Leadership & Innovation
Actively monitor CMS regulatory updates and NCQA standards as well as evolving health care industry regulatory trends and best practices in compliance programs Develop content to communicate the updates to key stakeholders
Product Development
Ensure the MHK solutions remain compliant with applicable regulatory requirements. i.e. Medicare, Medicaid, NCQA, FEP, QHP, etc.
Operations Support
Work with internal stakeholders to formulating strategy for solutions and partner to communicate a strong vision and strategy that will help to achieve the company's objectives for growth and differentiation. Be a needed resource for MHK various team members to assist in navigating critical or challenging client escalations/discussions as they pertain to any compliance or regulatory issues. Support new client implementations and existing client upgrades of MHK software solutions when needed for Utilization Management, Care Management, Pharmacy, Medical Appeals & Grievances to ensure the success of our clients. Provide ongoing subject matter expertise on the evolving care models and regulatory requirements in Medicare, Medicaid and other regulatory bodies Lead communication of the importance of compliance and any changes to regulations that will be shared with clients Facilitate internal audits to ensure ongoing compliance with MHK policies Assist clients with CMS program audit and NCQA accreditation preparation Adapt to competing demands, take on new responsibilities and adjust to meet changing priorities. Maintain client PowerPoint presentations that outline identified regulatory updates Track all issues referred to compliance up to and including resolution Identify and assess areas of compliance risk for MedHOK Back up Compliance Officer when needed for daily operations
Skill Requirements:
Five (5) years proven experience in health plan/managed care operations with utilization management, appeals, grievance, pharmacy, case management or quality management. Strong knowledge of CMS, Medicaid, QHP and federal regulations Outstanding communication and interpersonal abilities An analytical mindset with exceptional organizational skills Firsthand experience with operational procedures, reporting and auditing Methodical and diligent with outstanding planning abilities An analytical mind able to “see” the complexities of procedures and regulations Experience researching and summarizing applicable regulatory requirements Ability to write updates and memos to C-suite level internal and external clients Superb written, verbal communication and interpersonal skills Excellent in the use of Microsoft applications
Education Requirement:
Bachelor’s Degree / Associates Degree or relevant work experience
At MHK we help health plans and pharmacy benefit managers deliver optimal care management across every member’s health journey. We do this through state-of-the-art technology that provides critical insights from member enrollment and maintenance through every stage of care and compliance.
Benefits Snapshot:
Medical, vision, and dental plans for full time employees 401(k) offered with a generous match Benefits begin on first day of the month following employment Exercise/Health Club reimbursement opportunity Monthly dependent care reimbursement opportunity Short Term and Long Term disability Basic Term Life and AD&D Insurance
Paid Time Off
18 days Paid Time Off 15 Company Paid Holidays
EQUAL OPPORTUNITY EMPLOYER - VETERANS/DISABLED. Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionLegal IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Hearst Health by 2x Get notified about new Compliance Manager jobs in
Tampa, FL . Vice President - Sanctions Officer (Hybrid)Compliance Officer, Global Banking & Markets, US ComplianceDirector, PCG Compliance Policy ManagementCompliance Coordinator / Auditor (65621)Compliance Sr. Manager, Enterprise Policy GovernanceSanctions Senior Analyst - C12 - Tampa and Getzville - HybridDirector, Information Compliance Risk Management and AssuranceVP, Global AML Governance Risk & Controls - Audit & Compliance Review Manager (Hybrid)Compliance AML Risk Management- Wealth Advisory - C12 - TAMPAAVP, Compliance Sanctions Metrics Senior Analyst - C12 - Tampa - HybridImport/Export Customs Compliance ManagerMitchell & Ness Senior Manager Global Product Regulatory Compliance (EU Textiles & Garment)Information Technology Compliance ManagerSENIOR or LEAD NERC O&P COMPLIANCE SPECIALISTNERC CIP or SENIOR NERC CIP COMPLIANCE SPECIALIST Tampa, FL $141,440.00-$212,160.00 2 days ago SENIOR or LEAD NERC O&P COMPLIANCE SPECIALIST We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
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Compliance Manager
role at
Hearst Health 1 week ago Be among the first 25 applicants Join to apply for the
Compliance Manager
role at
Hearst Health Job Description
All potential candidates should read through the following details of this job with care before making an application.
The Compliance Manager will perform a range of duties including, but not limited to, evaluating all current and new compliance regulations, reviewing company policies and procedures, provide subject matter expertise and performing internal audits. The successful candidate will be able to multi-task and be an excellent communicator, with in-depth knowledge of the latest industry trends and regulations. Job Description
The Compliance Manager will perform a range of duties including, but not limited to, evaluating all current and new compliance regulations, reviewing company policies and procedures, provide subject matter expertise and performing internal audits. The successful candidate will be able to multi-task and be an excellent communicator, with in-depth knowledge of the latest industry trends and regulations.
Key Responsibilities:
Thought Leadership & Innovation
Actively monitor CMS regulatory updates and NCQA standards as well as evolving health care industry regulatory trends and best practices in compliance programs Develop content to communicate the updates to key stakeholders
Product Development
Ensure the MHK solutions remain compliant with applicable regulatory requirements. i.e. Medicare, Medicaid, NCQA, FEP, QHP, etc.
Operations Support
Work with internal stakeholders to formulating strategy for solutions and partner to communicate a strong vision and strategy that will help to achieve the company's objectives for growth and differentiation. Be a needed resource for MHK various team members to assist in navigating critical or challenging client escalations/discussions as they pertain to any compliance or regulatory issues. Support new client implementations and existing client upgrades of MHK software solutions when needed for Utilization Management, Care Management, Pharmacy, Medical Appeals & Grievances to ensure the success of our clients. Provide ongoing subject matter expertise on the evolving care models and regulatory requirements in Medicare, Medicaid and other regulatory bodies Lead communication of the importance of compliance and any changes to regulations that will be shared with clients Facilitate internal audits to ensure ongoing compliance with MHK policies Assist clients with CMS program audit and NCQA accreditation preparation Adapt to competing demands, take on new responsibilities and adjust to meet changing priorities. Maintain client PowerPoint presentations that outline identified regulatory updates Track all issues referred to compliance up to and including resolution Identify and assess areas of compliance risk for MedHOK Back up Compliance Officer when needed for daily operations
Skill Requirements:
Five (5) years proven experience in health plan/managed care operations with utilization management, appeals, grievance, pharmacy, case management or quality management. Strong knowledge of CMS, Medicaid, QHP and federal regulations Outstanding communication and interpersonal abilities An analytical mindset with exceptional organizational skills Firsthand experience with operational procedures, reporting and auditing Methodical and diligent with outstanding planning abilities An analytical mind able to “see” the complexities of procedures and regulations Experience researching and summarizing applicable regulatory requirements Ability to write updates and memos to C-suite level internal and external clients Superb written, verbal communication and interpersonal skills Excellent in the use of Microsoft applications
Education Requirement:
Bachelor’s Degree / Associates Degree or relevant work experience
At MHK we help health plans and pharmacy benefit managers deliver optimal care management across every member’s health journey. We do this through state-of-the-art technology that provides critical insights from member enrollment and maintenance through every stage of care and compliance.
Benefits Snapshot:
Medical, vision, and dental plans for full time employees 401(k) offered with a generous match Benefits begin on first day of the month following employment Exercise/Health Club reimbursement opportunity Monthly dependent care reimbursement opportunity Short Term and Long Term disability Basic Term Life and AD&D Insurance
Paid Time Off
18 days Paid Time Off 15 Company Paid Holidays
EQUAL OPPORTUNITY EMPLOYER - VETERANS/DISABLED. Seniority level
Seniority levelMid-Senior level Employment type
Employment typeFull-time Job function
Job functionLegal IndustriesHospitals and Health Care Referrals increase your chances of interviewing at Hearst Health by 2x Get notified about new Compliance Manager jobs in
Tampa, FL . Vice President - Sanctions Officer (Hybrid)Compliance Officer, Global Banking & Markets, US ComplianceDirector, PCG Compliance Policy ManagementCompliance Coordinator / Auditor (65621)Compliance Sr. Manager, Enterprise Policy GovernanceSanctions Senior Analyst - C12 - Tampa and Getzville - HybridDirector, Information Compliance Risk Management and AssuranceVP, Global AML Governance Risk & Controls - Audit & Compliance Review Manager (Hybrid)Compliance AML Risk Management- Wealth Advisory - C12 - TAMPAAVP, Compliance Sanctions Metrics Senior Analyst - C12 - Tampa - HybridImport/Export Customs Compliance ManagerMitchell & Ness Senior Manager Global Product Regulatory Compliance (EU Textiles & Garment)Information Technology Compliance ManagerSENIOR or LEAD NERC O&P COMPLIANCE SPECIALISTNERC CIP or SENIOR NERC CIP COMPLIANCE SPECIALIST Tampa, FL $141,440.00-$212,160.00 2 days ago SENIOR or LEAD NERC O&P COMPLIANCE SPECIALIST We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr