AmeriHealth Caritas Manager Compliance in Philadelphia, Pennsylvania

Manager Compliance


Description

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The Manager, Compliance reports to the Director, Compliance and manages a team of Compliance Operations Analysts that provides support in the oversight of all corporate and Plan operating divisions and subsidiary compliance functions and the implementation of compliance policy, process and control activities. In this position, the Manager, Compliance will be required to monitor the company’s compliance with contractual and regulatory performance metrics and will assist in the execution of operational changes required by regulations, contracts and other guidelines. The Manager, Compliance must also be able to perform the following functions:

  • Assist in the development of compliance methodologies and tools to monitor the effectiveness of contract compliance related processes.
  • Assist in the identification of gaps, weaknesses, deficiencies, and/or business productivity/efficiency opportunities.
  • Lead or assist in the issuance of internal and external corrective action plans and play an active role in the review and monitoring of remedial action plans.
  • Partner with Plan and corporate counterparts to review and assess objectives that ensure compliance with Plan and corporate policies and procedures, contracts, and state and federal regulations.
  • Implements and monitors metrics and ensures accurate reporting of compliance information.
  • Ensure that local compliance related issues and risks are reported and appropriately tracked to remediation.
  • Conduct ad hoc internal monitoring reviews of business operations for contract compliance.
  • Leadership role in responding to external audit requests at the Plan and corporate level.
  • Support cross-functional company-wide initiatives.

The Manager, Compliance must be able to operate independently with minimal management oversight and be able to manage competing priorities and deadlines that are subject to frequent change. Must possess and exercise excellent professional judgment in all interactions.

Education/Experience:

  • Bachelor’s Degree.
  • Certified in Health Care Compliance (CHCC) or other equivalent Compliance certifications or advanced degrees preferred.
  • 3 years or greater In a managed health care environment, including experience in the areas of compliance oversight.