Jobs

    Manager, Compliance-Regulatory - Pennsylvania, United States - Jefferson Health Plans

    Jefferson Health Plans
    Jefferson Health Plans Pennsylvania, United States

    1 week ago

    Default job background
    Description

    Why Choose Jefferson Health Plans?

    We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

    While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

    Perks of JHP and why you will love it here:

    • Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
    • Flextime and Work-at-Home Options
    • Benefits & Wellness Program including generous Time Off
    • Impact on the communities we service

    We are seeking a talented and enthusiastic Manager Compliance - Regulatory to join our team

    Summary/Objective:

    Under the direction of the Director of Compliance, support the administration and oversight of Health Partners Plans' (HPP) compliance program. In close collaboration with all business units, and other compliance divisions, this position will demonstrate leadership and provide compliance strategy throughout HPP in the organization's efforts to achieve key objectives, maintain and improve compliance. This Manager of Compliance will assist with the oversight of Company compliance with contractual and regulatory obligations and State and Federal requirements related to health insurance and managed care. This role is responsible for managing a diverse range of compliance-related responsibilities associated with HPP's Medicare Advantage/Prescription Drug Program, Pennsylvania Medicaid, Pennsylvania CHIP lines of business.

    This position will assist the Director of Compliance by managing key functions including, but not limited to:

    • HPP's regulatory and sub-regulatory research and policy initiatives and oversight.
    • Administration and oversight of HPP's internal and delegated vendor compliance program.
    • HPP's adherence to the Medicare Communications and Marketing Guidelines, as it pertains to existing & potential Medicare enrollee materials.
    • HPP's Dual Special Needs Plan (DSNP) State Medicaid Agency Contract oversight
    • Medicare Part C & D Data Reporting requirements
    • Medicare Part C & D Product Development Compliance
    • Day to day operational issues, as needed

    As the Manager Compliance - Regulatory, your daily duties may include:

    • Serve as primary support to Director of Compliance with oversight and execution of HPP's Compliance Program.
    • Serve as a point-of-contact for questions and complaints from internal and external customers regarding business practices, Code of Conduct issues and corporate policies, including issues of a sensitive or confidential nature.
    • Investigate and analyze facts and circumstances alleged in compliance complaints and inquiries, and provides prompt, concise answers to inquiries, complaints, and/or concerns regarding the Code of Conduct, corporate policies, and the Compliance Program.
    • Act as liaison to HPP's internal business units for day-to-day assistance with regulatory operational compliance issues and concerns, including requests for information and/or clarification.
    • Manage a team of compliance professionals who ensure adequate compliance oversight of regulatory affairs.
    • Manage the regulatory and sub-regulatory guidance distribution, tracking and reporting process.
    • Oversee the coordination and implementation efforts of new regulatory and/ or contractual requirements impacting HPP.
    • Assist with overseeing the development of internal policies and procedures.
    • Serve as a business partner/consultant with operational areas and assist in maintaining an understanding of and compliance with regulatory requirements, as well as the organization's internal policies and procedures.
    • Serve as compliance support in the application, product development and bid submission process.
    • Oversee and manage the Medicare Part C & D Data Reporting requirements, including assisting with Data Validation Audit related needs.
    • Ensure ongoing adherence with contractual provisions and reporting requirements set forth in our Pennsylvania D-SNP State Medicaid Agency Contract.

    Qualifications

    • Bachelor's Degree or significant experience with Healthcare compliance. Compliance professional certifications are preferred but not required.

    Skills, We Value:

    • Must be highly organized, analytical and detailed oriented.
    • Excellent interpersonal skills; must be an effective public speaker, presenter, and communicator with diplomacy and tact.
    • Strong oral and written communication skills.
    • Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
    • Must be able to facilitate meetings and achieve consensus regarding work plans and responsibilities.
    • Demonstrate ability to understand and interpret complex regulations.
    • Working experience with PC based applications such as Excel, PowerPoint, Word.
    • Excellent time management skills.
    • Strong conflict resolution skills.
    • Process and project management ability.
  • Jubilant Radiopharma

    Senior Quality Manager

    1 week ago

    Jubilant Radiopharma Pennsylvania, United States

    Jubliant DraxImage Radiopharmacies, a nationwide radiopharmaceutical company, is dedicated to nuclear medicine. We use our 25 years of experience in Nuclear Pharmacy to provide our customers with the best service and safest products. The Jubilant Radiopharmacies Network of facili ...

  • Larson Maddox

    Executive Director, Corporate Counsel

    2 weeks ago

    Larson Maddox Pennsylvania, United States

    I've partnered with a growing publicly-traded, commercial-stage biotech that is seeking a highly skilled and experienced Corporate Legal Counsel to join its dynamic legal team. The Executive Director will play a crucial role in managing and overseeing various legal aspects of the ...

  • Bridge Investment Group

    Regional Director of Wellness

    1 week ago

    Bridge Investment Group Pennsylvania, United States

    The Regional Director of Wellness will lead regional nursing teams to drive quality assurance, regulatory compliance, and positive health outcomes for our residents. You will promote the effective utilization and monitoring of health care resources, and lead a multidisciplinary t ...

  • First Quality

    Governance, Risk, Compliance Technology Lead

    1 week ago

    First Quality Pennsylvania, United States

    First Quality was founded in 1989 and, in nearly three decades, has grown to be a global privately held company with over 4,000 employees. Its corporate offices are located in Great Neck, New York, with manufacturing facilities and offices in Pennsylvania, South Carolina, Georgia ...

  • firstPRO, Inc

    Controller

    3 days ago

    firstPRO, Inc Pennsylvania, United States

    A PE-backed healthcare tech company HQ'd in Pennsylvania is seeking a talented and experienced Corporate Controller to join our finance team. This is a very hands-on role and the client is looking for those who have experience scaling businesses/VC backed companies/small co's/etc ...

  • Meet

    Medical Editor

    5 days ago

    Meet Pennsylvania, United States

    An exciting opportunity with a leading pharmaceutical advertising agency dedicated to crafting compelling and accurate medical communications. This exciting organization specializing in developing innovative strategies to promote pharmaceutical products and educate healthcare pro ...

  • Car Capital Technologies, Inc.

    Area Sales Manager

    1 week ago

    Car Capital Technologies, Inc. Pennsylvania, United States

    Position: Area Sales Manager · Company: Car Capital · Industry: Auto Finance/ Fintech · Location: Philadelphia, PA · Job Type: Full-Time · Role Definition: The primary role of the Area Sales Manager (ASM) is to consistently grow the business profitably by signing new dealers, get ...

  • Molecular Search

    Chief Financial Officer

    2 weeks ago

    Molecular Search Pennsylvania, United States

    Molecular Search is proud to partner with a leading CDMO specializing in drug product development and manufacturing. Our client is at the forefront of innovation in the pharmaceutical industry, providing comprehensive services to pharmaceutical companies worldwide. · Responsibili ...

  • Judge Direct Placement

    Sanitation Supervisor

    2 weeks ago

    Judge Direct Placement Pennsylvania, United States

    Our client is currently seeking a 3rd Shift Sanitation Supervisor. · Starts at 9 PM goes until done. · Summary · Reports directly to the Manager of Quality Assurance and is charged with maintaining consistent levels of sanitation and bacterial control. This position supervises st ...

  • Atlantic Group

    MEP Preconstruction Manager

    1 week ago

    Atlantic Group Pennsylvania, United States

    Job Overview - MEP Preconstruction Manager · Join our client's team as an MEP Preconstruction Manager and take a pivotal role in shaping the success of construction projects in the MEP (Mechanical, Electrical, Plumbing) sector. Whether you're a seasoned professional with years of ...

  • Atlantic Group

    Director Corporate Finance

    5 days ago

    Atlantic Group Pennsylvania, United States

    Job Overview - Director of Finance · Join our client's established company, boasting nearly a century of success, and be part of an exciting phase of growth driven by recent expansions into new ventures. This role offers a unique opportunity to contribute to the company's evoluti ...

  • ARM Group

    Sr Hydrogeologist/Project Manager

    1 week ago

    ARM Group Pennsylvania, United States

    ARM Group LLC is looking for a self-driven and experienced Hydrogeologist/Project Manager who has a strong technical background in the Solid Waste market, and embodies an ownership mentality As a Senior Hydrogeologist, you will collaborate with a team of multi-disciplined enginee ...

  • UPMC

    CRNA opportunity in beautiful North Central Pennsylvania

    1 week ago

    UPMC Pennsylvania, United States

    Are you looking for the opportunity to practice excellent medicine in a team environment focused on patient care? If you are a detail-oriented CRNA, able to function in a changing climate, and dedicated to exceptional patient care, we are interested in having you join our team at ...

  • Astrix

    Scientist

    4 days ago

    Astrix Pennsylvania, United States

    Responsibilities: · Coordinate global COA/PRO strategic plans in support of Early Development Teams (EDTs), Clinical Trial Teams (CTT) and/or Clinical Sub-teams (CST) to assure alignment with product franchise goals · Provide assistance on the selection and/or development of COA/ ...

  • Molecular Search

    Research And Development Manager

    6 days ago

    Molecular Search Pennsylvania, United States

    Position: Manager of R&D - Drug Product Delivery CDMO · Location: Onsite - Pennsylvania · Experience required: PHD, IP Experience, Drug Product (Transdermal, Oral Films, Formulation), Small Molecule experience · Molecular Search is currently seeking a highly qualified Manager o ...

  • Hueman Direct Hire

    Chief Operating Officer

    1 week ago

    Hueman Direct Hire Pennsylvania, United States

    A top client is hiring for a Chief Operations Officer (COO) to provide oversight of a National Manufacturing and Distribution Center Operations located in Northeastern Pennsylvania. · As COO, you will be on-site and responsible for overseeing operational efficiency, productivity, ...

  • Pennsylvania Health Care Association

    Executive Director, Assisted Living and Personal Care

    1 week ago

    Pennsylvania Health Care Association Pennsylvania, United States

    At PHCA, we pride ourselves on our reputation as the commonwealth's leading advocacy association, representing Pennsylvania's most vulnerable residents and their providers of care. Our team is looking to onboard an Executive Director of Assisted Living and Personal Care to enhanc ...

  • University of Pittsburgh Medical Center

    Clinical Director of Neonatology

    1 day ago

    University of Pittsburgh Medical Center Pennsylvania, United States

    The University of Pittsburgh Medical Center (UPMC) Magee-Women's Hospital is recruiting a Clinical Director of Neonatal Medicine. The Clinical Director will oversee the clinical management of patients in the 83-bed Level III NICU. The Neonatologist must have an MD or equivalent, ...

  • Oakburn Samuel

    Licensed Nursing Home Administrator

    1 week ago

    Oakburn Samuel Pennsylvania, United States

    LNHA Administrator Pennsylvania – High End Healthcare Provider · Very Competitive Salary and all depends on experience from $110K to $125K · Oakburn Samuel is currently looking for an outstanding experienced LNHA Administrator for a high end Skilled Nursing provider with a great ...

  • Winston Resources

    Director of Physician S

    4 days ago

    Winston Resources Pennsylvania, United States

    Exciting New Opportunity in the Philadelphia SuburbsThe Residency Director is responsible for the day to day administration of the ACGME residency/fellowship training program. The Program Director develops and maintains the educational quality of the training program and ensures ...