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Posted: 09-May-25
Location: Los Angeles, California
Categories:
Internal Number: 147410347
We are seeking a highly experienced Compliance Consultant to provide expert-level support in the development, implementation, and ongoing maintenance of our Medicare Advantage Vendor Management Program ("Program"). This position is crucial for ensuring that the organization remains in full compliance with CMS, DMHC, and other regulatory bodies, while also supporting the viability of new product offerings through vendor oversight. The ideal candidate will possess a deep working knowledge of CMS and DMHC regulatory requirements and industry best practices as they relate to Medicare Advantage health plan operations.
Key Responsibilities:
- Serve as a subject matter expert to guide internal and external stakeholders (i.e., vendors, FDRs) in maintaining regulatory compliance with CMS, DMHC, and other applicable healthcare regulations and settings.
- Collaborate with cross-functional teams to develop, implement, and maintain Program procedures tailored to the organization’s structure, operations, and product offerings.
- Provide day-to-day support for the execution of the Program’s compliance elements to ensure ongoing adherence with regulatory standards and enhance operational efficiency.
- Analyze the Program’s compliance practices and identify areas for improvement or modification based on regulatory changes or industry best practices.
- Effectively communicate compliance requirements and strategies across various levels of the organization.
- Monitor regulatory data submissions from all data contributors and conduct timely reviews of actionable system tasks.
- Assess and document potential compliance risks and provide actionable recommendations to mitigate these risks.
- Lead and support compliance training initiatives for staff and business partners, ensuring a strong understanding of relevant system operations, regulations and Program procedures.
- Collaborate with key stakeholders to ensure that all compliance requirements are integrated into business processes and operational workflows.
- Stay current with changes in relevant laws, regulations, and best practices to ensure the Program and organization’s compliance efforts remain up-to-date.
We’re seeking a detail-oriented, self-directed individual with:
- Bachelor’s Degree or five (5) years of Medicare Compliance experience at a health plan in lieu of a degree
- Minimum of 3 years of previous experience in a compliance or vendor oversight role
- Experience with Medicare Advantage health plan, particularly in an integrated system, is highly desired
- Strong working knowledge of CMS regulations, audits, expectations, and best practices
- Experience interacting with regulatory agencies and/or auditors to ensure compliance and address audit findings or inquiries
