Compliance Lead

CarePlus Health Plans Inc

Base: $115,200 - $158,400 py; bonus: eligible for ...
Fully remote
Medicare part c clinical utilization management
Federal and state regulatory compliance
Prior authorization and quality of care oversight
The Compliance Lead position at CarePlus Health Plans Inc. is a fully remote role focused on ensuring compliance with governmental requirements related to Medicare Part C. The ideal candidate will have significant experience in compliance or audit, along with a strong understanding of clinical utilization management

Job Summary

  • The Compliance Lead ensures adherence to governmental requirements with a specific focus on Medicare Part C clinical utilization management.
  • This role involves developing audit methodologies, leading onsite program audits, and serving as the subject matter expert during CMS reviews.
  • Humana offers competitive benefits including medical, dental, vision, 401(k) savings, and paid time off to support whole-person well-being.

Matching Summary

Match Score: 85

The Compliance Lead position at CarePlus Health Plans Inc. is a fully remote role focused on ensuring compliance with governmental requirements related to Medicare Part C. The ideal candidate will have significant experience in compliance or audit, along with a strong understanding of clinical utilization management.

Salary

Base: $115,200 - $158,400 per year; Bonus: Eligible for incentive plan based on performance; Benefits: Medical, dental, vision, 401(k), PTO, parental leave

Skills & Requirements

Must-have

  • Medicare Part C Clinical Utilization Management
  • Federal and State Regulatory Compliance
  • Prior Authorization and Quality of Care Oversight
  • Audit Methodology Development and Execution
  • 8+ Years Compliance or Audit Experience

Nice-to-have

  • Passion for improving consumer experiences
  • Project Management Professional (PMP) certification
  • Six Sigma certification
  • Advanced graduate degree in relevant field
  • Leadership experience on compliance committees

Key Requirements

  • Bachelor's Degree required
  • 8 or more years of compliance or audit related experience
  • Advanced experience with large data sets validation and communication

Work Rights

Not specified

Tailored Resume

Cover Letter