Job details

Compliance Manager

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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

COMMITMENT TO EQUAL OPPORTUNITY EMPLOYMENT

We are committed to cultivating and preserving a culture of inclusion and connectedness through collaboration. We grow and learn better together with a diverse team of employees. We welcome the unique contributions and the different perspectives of a diverse team. MHK is an equal opportunity employer - vets/disabled.

If you need a reasonable accommodation for any part of the employment process, please contact us by email at careers@mhk.com and let us know the nature of your request and your contact information. Requests for accommodation will be considered on a case-by-case basis. Please note that only inquiries concerning a request for reasonable accommodation will be responded to from this email address.

For more information, please visit Know Your Rights, Pay Transparency, and MHK EEO/AA Statement

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

Average salary estimate

$90000 / YEARLY (est.)

min

max

$80000K

$100000K

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What You Should Know About Compliance Manager, Hearst

If you’re looking for a stimulating career as a Compliance Manager with MHK in sunny Tampa, Florida, you’ve come to the right place! In this exciting role, you'll have the opportunity to get hands-on with evolving regulatory landscapes while leveraging your experience in health plan and managed care operations. As a Compliance Manager, you’ll evaluate compliance regulations and review company policies and procedures, ensuring our solutions remain compliant with Medicare, Medicaid, and NCQA standards. You won’t just monitor regulations—you're the thought leader who communicates vital updates to stakeholders. We believe that an excellent communicator with a knack for multitasking can transform compliance into a strategic advantage. You'll engage with clients, support new implementations, and conduct internal audits with meticulous attention to detail. We value your analytical mindset and organizational skills, which will help you navigate compliance complexities while fostering a culture of inclusion and collaboration. Whether you're facilitating audits, preparing for CMS program assessments, or adapting to change, your contributions will be crucial in our commitment to compliance excellence. Bring your strong knowledge of CMS and federal regulations, and let’s shape a compliant future together at MHK. Are you ready to be the go-to compliance expert in a dynamic team? Let’s connect!

Frequently Asked Questions (FAQs) for Compliance Manager Role at Hearst

What are the key responsibilities of a Compliance Manager at MHK in Tampa, Florida?

As a Compliance Manager at MHK, your core responsibilities include evaluating compliance regulations, developing communication content about updates for stakeholders, supporting operations, and facilitating internal audits. You will engage in product development to ensure compliance with Medicare, Medicaid, and NCQA standards while also assisting clients with implementation and upgrades of our software solutions.