Manager II - Operations

Role Description

Position Summary

The Compliance Manager is responsible for supporting the organization and its clients in meeting all applicable Federal and State regulatory requirements, as well as customer contractual compliance obligations. This role partners closely with customer health plans and internal stakeholders, applying strong auditing and compliance expertise to downstream vendors and business partners to ensure regulatory alignment and risk mitigation.

Key Responsibilities

• Communicate regulatory and compliance requirements clearly and effectively to internal teams and external partners.
• Prepare detailed analyses and reports based on audit findings, including actionable recommendations; maintain audit documentation and track corrective actions.
• Develop and deliver compliance training programs to internal teams and stakeholders to ensure understanding of regulatory requirements, organizational policies, and best practices.
• Ensure organizational audit readiness through proactive planning, gap assessments, and process improvements.
• Develop, implement, and maintain processes and procedures to mitigate identified and potential compliance risks.
• Collaborate with customer health plan partners across multiple lines of business, including Commercial, Medicare Advantage, and Medicaid.
• Implement processes to maintain compliance with applicable regulations and contractual obligations, including monitoring activities and validation of departmental audits.
• Collect, analyze, and identify trends from audit and investigation findings to support enterprise risk management strategies.
• Lead the planning, execution, and reporting of internal audits and ongoing monitoring activities.
• Establish and maintain effective systems of internal controls, including compliance management tools and reporting mechanisms.
• Facilitate organization-wide audits and certifications, including ISO 27001, SOC 1, SOC 2, and HITRUST.
  
  

Required Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Compliance, or a related field (Master’s degree preferred).
• Minimum of 7 years of experience in health plan operations or healthcare compliance.
• Prior experience in compliance, regulatory requirements, and audit activities.
• Advanced proficiency in Microsoft Word, Excel, and PowerPoint.
  
  

Preferred Qualifications

• Professional certification in healthcare compliance (e.g., CCEP, CHC) or completion of a graduate certificate program in healthcare compliance.
• Working knowledge of health plan compliance programs, including monitoring, auditing, and corrective action implementation.
  
  

Skills

Healthcare Compliance,Auditing,Healthplan Operations,Excellent Communication