Compliance UM Lead Health Care Insurance Plan exp. Work at Home from FL ONLY

Profile

Description

The Compliance (UM) Lead conducts and summarizes compliance audits. The Compliance (UM) Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Compliance (UM) Lead collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Ensures mandatory reporting completed. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Required Qualifications


Bachelor's Degree
3 years of healthcare Insurance plan experience
2 years of experience working in Medicare compliance, risk management, and/or auditing
Strong communication skills and collaboration skills with the ability to influence effectively
Advanced experience and knowledge of CMS and regulatory guidelines
Advanced experience leading special projects and producing metrics, measurements and trend reports
Strong attention to detail, focus on process, quality, and ability to operate under tight deadline
Strong knowledge of Microsoft Office applications, including Word, Excel, PowerPoint
Ability to exercise independent judgement with minimal direction many times under ambiguous circumstances
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


MBA or other Advanced Degree
Six Sigma, PMP certification, and/or compliance certification
Demonstrated experience with process documentation
Experience working in a Utilization Management or Clinical Operations department within a healthcare plan
Leadership experience in compliance, risk management or related areas
Bilingual English/Spanish is a plus. Candidate selected will not be communicating in Spanish with members.


Additional information


Schedule : Monday to Friday from 8 am to 5 pm, Overtime when the business needs and require for it.

Training: 1-2months, virtual training

Work Location (Address): Work At Home from Florida only.

% Travel: When required for in-office meetings or events, advanced notice will be given


Scheduled Weekly Hours

40

Company info

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