Job details

Associate Vice President, Compliance-Growth & Implementation(Managed Care Experience Required)

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Job Summary:

The Associate Vice President, Compliance - Growth and Implementation is responsible for supporting the organizations new market growth and provide compliance oversight and guidance related to significant regulatory implementations.

Essential Functions:

Assist with new market Medicaid expansions including regulatory guidance, policy and procedure drafting, readiness review and other implementation requirements
Assist with existing market Medicaid new contract implementations including regulatory guidance, policy and procedure drafting, readiness review and other implementation requirements
Provide compliance assistance to the operational and implementation teams to oversee effective readiness for the expansion of Medicare and Marketplace lines of business
Collaborate with the compliance team members to keep compliance team members informed of status of implementation and readiness activities
Draft at least quarterly status reports for the Corporate Compliance Officer/Committee and Enterprise Executive Leadership regarding implementation efforts and product expansion efforts
Direct periodic department or line of business compliance reviews to assess implementation efforts with regulatory requirements including company policies, state and federal laws and regulations
Direct and/or assist in the development of KCIs and other key metrics related to key Medicaid contractual requirement and Medicare and Marketplace requirements in new markets
Identify areas of risk requiring the establishment or enhancement of internal controls, policies and procedures, products and/or services, and training associated with any compliance obligations
Maintain positive and strategic relationships with internal and external stakeholders
Provide management and oversight of professional staff
Perform any other job duties as requested

Education and Experience:

Bachelor’s degree in business or related field or equivalent years of relevant work experience is required
MBA or JD strongly preferred
Minimum of seven (7) years of healthcare operations or clinical experience or providing counsel to same, including three (3) years in Government Program products is required
Minimum of five (5) years of Compliance Program leadership experience or five (5) years health plan quality program experience is required with focus on compliance audit/monitoring activities is required
Minimum of three (3) years previous management experience is required, compliance oversight leadership experience within healthcare operations is preferred
Significant regulatory implementation experience is required
Support new market expansions is preferred

Competencies, Knowledge and Skills:

Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid/Marketplace and Medicare)
Exceptional project management skills
Strategic management and leadership skills
Ability to work independently and within a matrixed environment
Attention to detail and strong communication skills necessary
Demonstrated critical listening and thinking skills
Negotiation skills
Time management skills including creation and maintenance of project timelines
Decision making/problem solving skills
Advanced level experience in Microsoft Word, Excel and PowerPoint

Licensure and Certification:

Certified in Healthcare Compliance (CHC) preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$132,900.00 - $232,700.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

Average salary estimate

$182800 / YEARLY (est.)

min

max

$132900K

$232700K

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What You Should Know About Associate Vice President, Compliance-Growth & Implementation(Managed Care Experience Required), CareSource

CareSource is looking for a dynamic Associate Vice President, Compliance - Growth & Implementation to join our team remotely! In this role, you will be the driving force behind our organization's new market growth, ensuring that compliance oversight is effectively managed in line with significant regulatory implementations. You’ll assist with Medicaid expansions and contract implementations, providing your expertise in regulatory guidance and ensuring our operations align with policy and procedure requirements. Collaboration is key, as you'll work closely with our operational teams to oversee readiness for Medicare and Marketplace expansions. You'll be tasked with drafting quarterly reports for leadership, conducting compliance reviews, and identifying risks that necessitate the enhancement of internal controls. We’re seeking someone who thrives in a strategic environment, has strong leadership skills, and can foster positive relationships with stakeholders. A Bachelor's degree is essential, while an MBA or a JD is preferred, alongside significant experience in healthcare compliance. If you’re looking for a position that challenges you and allows you to promote compliance in a growing field, the Associate Vice President role at CareSource could be a perfect fit for you!

Frequently Asked Questions (FAQs) for Associate Vice President, Compliance-Growth & Implementation(Managed Care Experience Required) Role at CareSource

What are the main responsibilities of the Associate Vice President, Compliance - Growth & Implementation at CareSource?

The Associate Vice President, Compliance - Growth & Implementation at CareSource is responsible for ensuring compliance during market expansions. Key duties include providing regulatory guidance for Medicaid contracts, drafting policies, overseeing operational readiness for new Medicare and Marketplace lines of business, and creating compliance metrics. This role also involves managing a professional team and drafting quarterly status reports for senior leadership.