Compliance Manager at MEDHOK, INC in Tampa, Florida

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:

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  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
  
  
  
  


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  Product Development 
  
  
  
  • Ensure the MHK solutions remain compliant with applicable regulatory requirements. i.e. Medicare, Medicaid, NCQA, FEP, QHP, etc.  
  
  
  
  


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  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