This position is located in Kearny Mesa, San Diego
8-hour shift; weekends as needed
Required Skills and Qualifications
- Bachelor’s degree in related field
- 3 to 5 years’ of compliance experience within the health care industry
- Working knowledge of Medicare Advantage regulations, resources and processes
- Experience designing, conducting and monitoring compliance audits
- Knowledge of health plan operations and issues
- Strong knowledge of compliance principles, practices, and procedures
- Strong leadership and management skills
- Excellent organizational and interpersonal skills
- Excellent business acumen and writing skills
- Exceptional diplomacy skills to effectively resolve issues under sometimes tense and stressful circumstances
- Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity
Preferred Skills and Qualifications
- Master’s degree or Juris Doctorate
The Manager Medicare Compliance is responsible for providing effective leadership in Medicare Compliance. Manages the development, implementation, compliance and maintenance of Medicare Part C and D policies, procedures and programs. Ensures internal departments understand and implement Center for Medicare & Medicaid Services (CMS) and Department of Managed Health Care (DMHC) rules, policies, and regulations. Responsible for delegated oversight and audit activities for internal departments and first tier, downstream and related entities. Develops and implements Medicare compliance training programs. Tracks and analyzes state and federal rules and regulations regarding Medicare Advantage plans. Monitors industry best practices and makes recommendations for organizational policy and procedure change that will result in compliance. Interacts effectively with various internal and external departments to provide assistance and information. Efficiently and effectively documents information and activities so they can be tracked, trended and utilized for compliance verification and process improvement. Promotes the satisfaction, development and productivity of Medicare Compliance staff. Participates as part of, and in support of, a management team that works collaboratively to ensure the success of Sharp Health Plan’s goals, objectives, and strategic initiatives.
The Legislative and Regulatory Affairs Department of Sharp Health Plan is responsible for ensuring the Plan's compliance with all applicable state and federal rules, regulations, and laws, including CMS, PHS, IRS, HIPAA, ERISA, COBRA, ACA, and the Knox-Keene Act.
Sharp Health Plan is San Diego’s largest locally based commercial health plan. With a personal approach and a network of medical groups and physicians, Sharp Health Plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.
As the top-rated health plan in California*, Sharp Health Plan serves a growing number of companies, large and small, in San Diego and southern Riverside counties.
* Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, 2016
Essential Physical Requirements May Include:
Incumbent spends approximately 4-6 hours per day sitting at desk, entering data on computer terminal and talking on telephone. Incumbent spends approximately 1-2 hours per day walking between Plan departments. Must be able to hear and speak clearly by telephone. Must be able to meet frequent deadlines and tight schedules. Must be able to lift 5 – 20 pounds, primarily paper reports and filing. Ability to travel between Sharp Health Plan, other Sharp HealthCare facilities, customer locations and community resources. Must provide own transportation.
Sharp HealthCare is proud to be an Equal opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.
Keyword: Manager, leadership, Health Plan, Managed Care, Compliance, Regulatory, Medicare