Care Management Compliance Manager

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, United States
Base: $79,560.00 - $115,720.80/annual; bonus/equit...
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Bachelor's degree required
Unrestricted rn license in state of residence
3-5 years clinical experience in healthcare
** The Care Management Compliance Manager at Mass General Brigham Health Plan is responsible for ensuring compliance with legal and regulatory standards within care management operations. The role requires collaboration with various departments and offers a fully remote working arrangement. **

Job Summary

  • The Care Management Operational Compliance Manager reports to the Director of Clinical Operational Compliance and collaborates closely with the Legal, Regulatory Affairs, and Compliance department.
  • This role involves conducting standard qualitative and quantitative chart reviews to monitor adherence to contractual requirements and facilitating readiness audits.
  • The position offers a competitive base pay ranging from $79,560.00 to $115,720.80 annually along with comprehensive benefits and career advancement opportunities.

Matching Summary

Match Score: 75

** The Care Management Compliance Manager at Mass General Brigham Health Plan is responsible for ensuring compliance with legal and regulatory standards within care management operations. The role requires collaboration with various departments and offers a fully remote working arrangement. **

Salary

Base: $79,560.00 - $115,720.80/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive benefits, career advancement, differentials, premiums, bonuses, and recognition programs

Skills & Requirements

Must-have

  • Bachelor's degree required
  • Unrestricted RN license in state of residence
  • 3-5 years clinical experience in healthcare
  • Knowledge of CMS and State-specific requirements
  • Experience with contract interpretation and compliance

Nice-to-have

  • Master's degree preferred
  • 5 years clinical nursing experience
  • Managed care experience at management level
  • Strong analytical and problem-solving skills
  • Experience leading multidisciplinary team projects

Key Requirements

  • Bachelor's Degree (Master's preferred)
  • Unrestricted RN license
  • 3-5 years clinical healthcare experience
  • Medicare/Medicaid/DSNP Managed Care experience
  • Contract interpretation/compliance experience

Work Rights

Not specified

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