Contract Compliance Manager

6 days left

Location
Virginia Beach, VA
Salary
Competitive
Posted
Dec 01, 2018
Closes
Dec 22, 2018
Ref
118095BR
Function
Other
Industry
Other
Hours
Full Time
Overview:

Optima Health is hiring a Contract Compliance Manager to join our Government Programs Administration team in Virginia Beach, VA.

Hours/Shift: Monday - Friday, 8am-5pm

Optima Health is a service of Sentara Healthcare and offers creative and innovative services and solutions to help members, providers, and employers get the most out of their health plan and life!

The Contract Compliance Manager functions as a high level liaison between operational departments, government programs administration and compliance departments to include functioning as an intermediary between the PLAN and DMAS for the resolution of day to day issues.

This role is dynamic and comprehensive encompassing functions and active participation in:
  • Regulatory Oversight and Management: monitors and interprets policy and regulatory issues, develops reports, serves on regulatory committees
  • Contracting Compliance and Reporting: Reviews Medicaid amendment changes, manages quarterly requirement, primary contact to IT department for reports, assisting operational departments in development of policies and develops monitoring activities through internal audits.
  • Advertising, Enrollment & Member Communication and Compliance: Auditing, document changes, compliance, content support to operations departments regarding the Medicaid contract and Medicaid Marketing Materials
  • Vendor Compliance: manages and maintains relationships, implements corrective action plans, monitors compliance including reporting, auditing, and financial projections.
  • Regulatory Audit Compliance: develops audit plans, contractual agreements, revises policies, supports internal audits and assists with external audit readiness reviews.
  • Project Management: Identifies improvement opportunities, manages change processes, monitors performance
  • Leadership: as a Subject Matter Expert, participates in supports Government programs, health plans both individually and collaboratively, provides guidance, identifies at risk factors and implements remedies.

Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission "to improve health everyday." This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support --every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Other
Keyword: Contract, audit, health plan, managed care, health insurance, Medicaid, compliance, reporting, project management.

Equal Opportunity Employer

Responsibilities:

This position is a liaison between Medicaid and all internal departments to interpret and apply Medicaid contract /regulatory requirements. Job objective is to to meet the Virginia Medicaid contractual requirements and support quality and integrity efforts for Government Programs. Responsibilities include assisting with interpretation of the Virginia Medicaid contract, laws and regulations; developing and implementing contractual changes through work plans, policies and procedures, and activities; monitoring and auditing department functions against contract requirements.

Qualifications:

Education Level
Bachelor's Level Degree

Experience
Required: Managed Care - 5 years

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