Job Summary

• The Clinical Compliance Program Manager will lead internal audits to evaluate compliance with NCQA standards and state regulations.
• This role requires applying clinical knowledge to assess medical records against medical necessity criteria and accreditation requirements.
• The position offers a comprehensive benefits package including paid time off, medical/dental/vision insurance, and 401(k) matching.

Matching Summary

Salary

Base: $95,490.00 - $116,710.00; Bonus/Equity: Eligible for variable pay; Benefits: Comprehensive package including PTO, medical/dental/vision, 401(k)

Skills & Requirements

Key Requirements

• RN or clinical professional degree with active MA license
• 3 years of Utilization Management experience at a health plan
• 2-5 years of experience with NCQA and regulatory standards
• Bachelor's degree required
• 1-2 years of people or project management experience

Work Rights