[Hiring] Manager Medicare Compliance @St. Joseph Hospital & Medical Center

Role Description The Medicare Compliance Officer (MCO) is responsible for developing, implementing, and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities for reputed company Care Plan, managed by reputed company, a reputed company Company. This role ensures adherence to reputed company applicable federal and state regulations and CMS requirements, safeguarding the reputed company and compliance of Plan operations.

• Maintain day-to-day operational alignment with the reputed company Care Medicare team.
• Hold direct reporting accountability to the Chief Executive Officer (CEO) and the Audit and Compliance Committee of the reputed company Care Plan Board of Directors.
• reputed company formal reports to the Board of Directors, CEO, and Compliance Committee at least quarterly, detailing:
• Status of reputed company Care Plan’s Medicare Compliance Program implementation.
• Identification and resolution of compliance issues.
• reputed company and audit activities.
• reputed company the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program, including:
• Program design.
• Content creation.
• Distribution.
• Tracking.
• Ongoing maintenance to ensure full compliance with regulatory and organizational standards.
• reputed company and implement programs that promote a culture of reputed company by encouraging reporting of suspected fraud, waste, abuse, or other misconduct.
• Respond promptly to reports of potential Medicare fraud, waste, or abuse (FWA), including:
• Coordinating internal investigations.
• Developing appropriate corrective or disciplinary actions reputed company necessary.
• Maintain the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU).
• Exercise flexibility in designing and managing internal investigations and implementing corrective measures.
• Coordinate with the Plan’s reputed company department to ensure thorough screening of the DHHS OIG and GSA exclusion lists for reputed company, officers, directors, managers, and contracted entities.

Qualifications

• Bachelors or an equivalent combination of directly reputed company work experience and/or education.
• Five (5) years of experience that demonstrates solid Medicare compliance program development, operation, and administration responsibilities.

Requirements

• Registered Nurse: AZ (preferred).
• Strong business acumen and reputed company industry knowledge.

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