Sr. Manager or Associate Director of Compliance

Job Summary

Required Qualifications

• Bachelor’s degree in healthcare, business, or a related field
• At least 5 years of Medicare Advantage and Prescription Drug Plan compliance experience
• At least 5 years of regulatory or compliance experience, preferably within a managed care organization or health plan
• At least 3 years of leadership experience with direct responsibility for compliance functions
• Experience reviewing, analyzing, and operationalizing CMS HPMS memos, CMS guidance, state regulatory documentation, notices, bulletins, and related compliance requirements
• Experience developing and tracking implementation plans in response to CMS, HPMS, and state regulatory guidance
• Experience with risk management, auditing, monitoring, internal controls, and delegated entity oversight
• CMS claims experience preferred, including familiarity with claims timeliness, payment accuracy, denial requirements, and CMS reporting expectations
• Finance-related compliance oversight experience preferred, including familiarity with financial reporting, solvency-related documentation, regulatory filings, and compliance support for finance operations
• CMS utilization management experience preferred, including knowledge of organization determinations, prior authorization, medical necessity review, timeliness standards, and CMS UM requirements
• SNP experience preferred, including familiarity with Model of Care requirements, care coordination, HRAs, ICPs, ICTs, and SNP-specific CMS expectations
• Quality experience preferred, including knowledge of quality improvement activities, performance monitoring, member experience, and health plan quality initiatives
• Star Ratings experience preferred, including familiarity with CMS Star Ratings measures, performance improvement efforts, data monitoring, and cross-functional coordination to support improved outcomes
• Certified in Health Care Compliance preferred, or ability to obtain certification within 12 months of hire
• Strong knowledge of CMS regulations, Medicare Advantage, Part D, HPMS communications, and applicable state regulatory requirements
• Experience with compliance auditing, training, policy development, corrective action plans, investigations, regulatory reporting, and implementation of regulatory changes
• Proficiency in Microsoft Office, including Word, Excel, PowerPoint, and SharePoint
• Strong research, analytical, organizational, written communication, and verbal communication skills
• Ability to work on-site daily at the company’s Huntington Beach, California office location