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Program Manager, Medicaid Compliance - Rockville, MD

Location: Rockville, MD Job Number: 672795 Date posted: 02/07/2018
Description: This position is responsible for developing and maintaining a Regional Medicaid Compliance Program designed to partner closely with the KPMAS Medicaid Office and MAPMG to advise regional staff on contract and regulatory Medicaid requirements in Maryland, Virginia and the District of Columbia; develop functional procedures compliant with state Medicaid program requirements; monitor performance with Medicaid compliance requirements; and conduct education and training of appropriate personnel on state programs compliance issues, as needed. The Medicaid Compliance Program Manager will serve as the point person to facilitate external and internal Medicaid Regulatory Audits. This includes audit preparation, facilitating the collection of pre-audit materials, and working with the Medicaid Operations Team and other internal business partners to develop, report and monitor any associated action plans responding to audit recommendations or other issues of non-compliance. In addition, this position is responsible for maintaining an informational reporting relationship and information exchange with the National Compliance Office.

Essential Responsibilities:
  • Monitor and evaluate regional compliance with state programs contract(s) and Medicaid regulatory requirements. Advise regional departments and staff on Medicaid requirements related to regulatory Medicaid requirements in Maryland, Virginia and (eventually) the District of Columbia. Develop agreement among regional leaders and managers of key departments to provide oversight of compliance activities across all work teams and processes that affect state programs members of KPMAS. Review and oversee submission and negotiation for approval of all marketing materials.
  • Work effectively with Health Plan and MAPMG leaders and our labor partners to effectively provide compliance oversight of Medicaid program. Create and establish effective means of interdepartmental communication and coordination of state programs compliance contract issues and activities both directly and through the appropriate committee structure. Present state programs compliance and regulatory issues at meetings with appropriate operations areas, and serve on appropriate compliance workgroups as directed by the VP, Regional Compliance Officer or Compliance Director. Participate on state contractors committees as appropriate. Participate on Medicaid workgroups or projects with the National Compliance Office.
  • Interpret state and local Medicaid requirements for affected departments and assist departments in developing operational policies and procedures, specialized training and other functions to comply with state programs contract requirements, regulations, operational policy letters and others guidance. Communicate to organizational departments new or changing legislation and contract requirements. Assist the organization in accessing impact of the changes and provide compliance oversight for the implementation of new or revised regulatory requirements related to the Medicaid contracts.

  • Work with operational teams to develop internal monitoring tools that evaluate compliance with Medicaid requirements. Review the results of internal monitoring and work with the operational areas to develop corrective actions when noncompliance is identified. Conduct risk assessments of operational processes and functions in order to prioritize where additional compliance review is warranted. Develop and conduct adhoc audits of processes to ensure compliance with contract requirements and internal policies and procedures.
  • Coordinate preparations for state and local contract monitoring visits and for internal audits. Coordinate the development of corrective action plans and appropriate activities following an audit. Assure timely submission of corrective action plans to the state agencies and respond timely to other items, pertaining to audits from the state agencies. Serve as primary contact with State agency personnel for issues related to compliance with the Medicaid contracts.
  • Other duties as assigned by the VP, Regional Compliance Officer or Director, Audit Readiness, Legislative and Product Compliance.

  • Basic Qualifications:

  • Minimum five (5) years experience in a health insurance product and/or health insurance regulatory setting required.
  • Minimum five (5) years of experience in compliance.
  • Minimum three (3) years experience working with Medicaid contract issues or similar requirements.
  • Minimum three (3) years experience in interpreting statutes and regulations and working in a regulatory environment.
  • Minimum three (3) years experience performing audits and/or preparing for and responding to regulatory audits by federal and state regulators.
  • Bachelor's Degree.
    License, Certification, Registration
  • N/A

    Additional Requirements:
  • Demonstrated ability to interpret complex data.
  • Demonstrated ability to effectively collaborate with executive and medical staffs, administration, department heads and other personnel, as well as external contacts.
  • Demonstrates customer-focused services skills.
  • Demonstrated ability to work independently and motivate people to achieve shared goals is required.
  • Demonstrates clear organizational skills.
  • Excellent written and verbal communication skills.
  • Experience in education, training and oral presentation.
  • Experience with PC, relevant applications, analytical and statistical skills.
  • Project management skills.
  • Skills in negotiation and conflict resolution.
  • Demonstrates problem solving and decision making skills.
  • Ability to manage complex report structure required.
  • Project management skills (Demonstrated ability to manage multiple large complex priorities and projects and meet deadlines).

    Preferred Qualifications:
  • Experience with Virginia, Maryland and DC regulations, Medicaid, standards and MCO requirements.
  • Strong financial background.
  • Ability to interpret data and collaborate with teams.
  • Demonstrated effective ability to work with executive and medical staffs, administration, department heads and other KPMAS personnel, as well as external contacts.
  • Professional certification in healthcare Compliance (CHC).

  • J.D. or Master's Degree.

    Primary Location: Maryland,Rockville,Rockville Regional Offices 2101 E. Jefferson St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: Varies Working Hours End: Varies Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Compliance / Privacy / Regulatory Department: Regional Compliance Travel: Yes, 10 % of the Time
    Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
  • About Compliance, Privacy & Regulatory Careers

    Compliance, Privacy & Regulatory Careers

    We've established a comprehensive, world-class compliance, privacy, and regulatory program, giving you the chance to make a difference in the lives of millions. As a member of this team, you'll engage with internal stakeholders to foster an environment of safety and trust for our members, physicians, and employees alike.

    Helping to establish and maintain an effective compliance program, you'll ensure that we operate according to the highest ethical standards and follow all applicable laws, standards, policies, and procedures. Everything we do — from developing policies and training to protecting privacy and security — reinforces our commitment to our members, regulators, and the communities we serve.

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