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Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for 30+ years and we continue to be a transformative force in the industry by placing people over profits. 

CareSource is and will always be member-first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to over 2.3 million members through plan offerings including Marketplace, Medicare products and Medicaid. With our team of 4,500+ employees located across the country, we continue to clear a path to better life for our members. Visit the "Life"​ section to see how we are living our mission in the states we serve.

Finance

CareSource

You need a Bachelor's degree, 5+ years in healthcare compliance, familiarity with government programs, strong communication skills, and data analysis ability. JD preferred; compliance cert is a plus.

You will lead Medicaid regulatory processes, ensure compliance training, manage communication of updates, oversee reporting, and collaborate with teams to mitigate risks and enhance tool effectiveness.

Banking & Finance

<p>The Manager, Compliance Regulatory Distribution Management serves as the leader, subject matter expert of the Medicaid compliance regulatory distribution management team.</p><p><strong style="background-color: transparent;">Essential Functions:</strong></p><ul><li>Leads the overall process, reporting, training and team for the Medicaid regulatory distribution management process which includes validating regulatory implementations</li><li>Develop standard processes and protocols to ensure effective Medicaid regulatory implementations through procedure reviews, timely distribution of changes, and appropriate and validated evidence for compliant implementations</li><li>Establish a process to create and maintain tool for effective management of overall guidance of Federal Medicaid regulations and the respective connection with each state Medicaid element</li><li>Oversee the process, reporting, training and communications to ensure that regulatory updates including, but not limited to, federal Medicaid regulation changes, state Medicaid regulation changes, Medicaid contract changes and any other regulation requirements for maintaining a Medicaid program in each state where CareSource legal entities are in effect are timely disseminated and implemented</li><li>Establish consistent and regular communications with business owners and Plan Compliance Officers to discuss activity in the RDM process as well as identification of any risks or issues&nbsp;</li><li>Ensure timely and accurate recording and reporting of items entered into the regulatory distribution management tool</li><li>Focus on prevention including, but not limited to, assisting with policy and procedure review, reading regulations and summarizing analysis of regulations via white-papers for distribution to the business, and responding to and tracking regulatory questions from the business in respective compliance tracking tools</li><li>Manage user acceptance testing (UAT) of the regulatory distribution management tool and promote regulatory distribution management tool and process efficiency and effectiveness by developing, modifying, and implementing changes to the tool and process using feedback received from business partners and other tool users</li><li>Maintain positive strategic relationships and support a culture of compliance based on the company's core values</li><li>Maintain and enhance current understanding of federal/state laws and regulations regarding Medicaid requirements as well as general compliance best practices and industry standards</li><li>Perform data analysis and support evolution to the use of predictive analytics and proactive identification of risk concerning new regulatory requirements and their impact to CareSource</li><li>Distribute key statistics and regulatory distribution management trends, identifying risk mitigation and performance improvement opportunities to Compliance and company leadership</li><li>Report non-compliance with regulatory implementations to Compliance leadership and plan leadership</li><li>Collaborate with Compliance leadership and Plan Compliance Officers in development of effective regulatory distribution management training materials including, but not limited to, training on the tool, education on rules and regulations or government program processes</li><li>Perform any other job duties as requested</li></ul><p><strong style="background-color: transparent;">Education and Experience:</strong></p><ul><li>Bachelor’s Degree or equivalent years of relevant work experience is required&nbsp;</li><li>Juris Doctor (JD) or equivalent law degree is preferred</li><li>Minimum of five (5) years of healthcare compliance, government relations, regulatory, or equivalent experience is required</li><li>Government Program products is required</li><li>Prior management experience is preferred</li><li>Managed care or other healthcare related experience is preferred</li></ul><p><strong style="background-color: transparent;">Competencies, Knowledge and Skills:</strong></p><ul><li>Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare, and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entities</li><li>Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred</li><li>Data analysis ability to produce meaningful insight and drive appropriate action</li><li>Demonstrated understanding of compliance and regulatory fundamentals specifically related to managed care and government programs <span style="background-color: transparent;">(CMS/HHS/DOI/Medicaid)</span></li><li>Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement</li><li>Proven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focus</li><li>Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including but not limited to internal leadership at all levels, internal and external legal counsel, Corporate Compliance, State and Federal Regulators</li><li>Strong decision making and problem-solving skills</li><li>Demonstrated success in working in a matrixed environment</li><li>Detail orientated with focus on maintaining accurate information in tools as required</li><li>Effective active listening and critical thinking skills</li><li>Time management skills including creation and maintenance of project timelines</li><li>Advanced level experience in Microsoft Word, Excel and PowerPoint</li></ul><p><strong style="background-color: transparent;">Licensure and Certification:</strong></p><ul><li>Compliance designation preferred</li></ul>

The Manager, Compliance Regulatory Distribution Management serves as the leader, subject matter expert of the Medicaid compliance regulatory distribution management team.Essential Functions:Leads the overall process, reporting, training and team for the Medicaid regulatory distribution management process which includes validating regulatory implementationsDevelop standard processes and protocols to ensure effective Medicaid regulatory implementations through procedure reviews, timely distribution of changes, and appropriate and validated evidence for compliant implementationsEstablish a process to create and maintain tool for effective management of overall guidance of Federal Medicaid regulations and the respective connection with each state Medicaid elementOversee the process, reporting, training and communications to ensure that regulatory updates including, but not limited to, federal Medicaid regulation changes, state Medicaid regulation changes, Medicaid contract changes and any other regulation requirements for maintaining a Medicaid program in each state where CareSource legal entities are in effect are timely disseminated and implementedEstablish consistent and regular communications with business owners and Plan Compliance Officers to discuss activity in the RDM process as well as identification of any risks or issues Ensure timely and accurate recording and reporting of items entered into the regulatory distribution management toolFocus on prevention including, but not limited to, assisting with policy and procedure review, reading regulations and summarizing analysis of regulations via white-papers for distribution to the business, and responding to and tracking regulatory questions from the business in respective compliance tracking toolsManage user acceptance testing (UAT) of the regulatory distribution management tool and promote regulatory distribution management tool and process efficiency and effectiveness by developing, modifying, and implementing changes to the tool and process using feedback received from business partners and other tool usersMaintain positive strategic relationships and support a culture of compliance based on the company's core valuesMaintain and enhance current understanding of federal/state laws and regulations regarding Medicaid requirements as well as general compliance best practices and industry standardsPerform data analysis and support evolution to the use of predictive analytics and proactive identification of risk concerning new regulatory requirements and their impact to CareSourceDistribute key statistics and regulatory distribution management trends, identifying risk mitigation and performance improvement opportunities to Compliance and company leadershipReport non-compliance with regulatory implementations to Compliance leadership and plan leadershipCollaborate with Compliance leadership and Plan Compliance Officers in development of effective regulatory distribution management training materials including, but not limited to, training on the tool, education on rules and regulations or government program processesPerform any other job duties as requestedEducation and Experience:Bachelor’s Degree or equivalent years of relevant work experience is required Juris Doctor (JD) or equivalent law degree is preferredMinimum of five (5) years of healthcare compliance, government relations, regulatory, or equivalent experience is requiredGovernment Program products is requiredPrior management experience is preferredManaged care or other healthcare related experience is preferredCompetencies, Knowledge and Skills:Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare, and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entitiesFamiliarity with Healthcare operations and/or clinical concepts, practices and procedures is preferredData analysis ability to produce meaningful insight and drive appropriate actionDemonstrated understanding of compliance and regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid)Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcementProven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focusDemonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including but not limited to internal leadership at all levels, internal and external legal counsel, Corporate Compliance, State and Federal RegulatorsStrong decision making and problem-solving skillsDemonstrated success in working in a matrixed environmentDetail orientated with focus on maintaining accurate information in tools as requiredEffective active listening and critical thinking skillsTime management skills including creation and maintenance of project timelinesAdvanced level experience in Microsoft Word, Excel and PowerPointLicensure and Certification:Compliance designation preferred

Manager, Compliance Regulatory Distribution Management - CareSource

United States

<div>
 <div>
  Job Summary:
 </div>
 <div>
   The Manager, Compliance Regulatory Distribution Management serves as the leader, subject matter expert of the Medicaid compliance regulatory distribution management team.
 </div>
 <div></div>
 <div>
   Essential Functions:
 </div>
 <ul>
  <li> Leads the overall process, reporting, training and team for the Medicaid regulatory distribution management process which includes validating regulatory implementations</li>
  <li> Develop standard processes and protocols to ensure effective Medicaid regulatory implementations through procedure reviews, timely distribution of changes, and appropriate and validated evidence for compliant implementations</li>
  <li> Establish a process to create and maintain tool for effective management of overall guidance of Federal Medicaid regulations and the respective connection with each state Medicaid element</li>
  <li> Oversee the process, reporting, training and communications to ensure that regulatory updates including, but not limited to, federal Medicaid regulation changes, state Medicaid regulation changes, Medicaid contract changes and any other regulation requirements for maintaining a Medicaid program in each state where CareSource legal entities are in effect are timely disseminated and implemented</li>
  <li> Establish consistent and regular communications with business owners and Plan Compliance Officers to discuss activity in the RDM process as well as identification of any risks or issues</li>
  <li> Ensure timely and accurate recording and reporting of items entered into the regulatory distribution management tool</li>
  <li> Focus on prevention including, but not limited to, assisting with policy and procedure review, reading regulations and summarizing analysis of regulations via white-papers for distribution to the business, and responding to and tracking regulatory questions from the business in respective compliance tracking tools</li>
  <li> Manage user acceptance testing (UAT) of the regulatory distribution management tool and promote regulatory distribution management tool and process efficiency and effectiveness by developing, modifying, and implementing changes to the tool and process using feedback received from business partners and other tool users</li>
  <li> Maintain positive strategic relationships and support a culture of compliance based on the company's core values</li>
  <li> Maintain and enhance current understanding of federal/state laws and regulations regarding Medicaid requirements as well as general compliance best practices and industry standards</li>
  <li> Perform data analysis and support evolution to the use of predictive analytics and proactive identification of risk concerning new regulatory requirements and their impact to CareSource</li>
  <li> Distribute key statistics and regulatory distribution management trends, identifying risk mitigation and performance improvement opportunities to Compliance and company leadership</li>
  <li> Report non-compliance with regulatory implementations to Compliance leadership and plan leadership</li>
  <li> Collaborate with Compliance leadership and Plan Compliance Officers in development of effective regulatory distribution management training materials including, but not limited to, training on the tool, education on rules and regulations or government program processes</li>
  <li> Perform any other job duties as requested</li>
 </ul>
 <div></div>
 <div>
   Education and Experience:
 </div>
 <ul>
  <li> Bachelor’s Degree or equivalent years of relevant work experience is required</li>
  <li> Juris Doctor (JD) or equivalent law degree is preferred</li>
  <li> Minimum of five (5) years of healthcare compliance, government relations, regulatory, or equivalent experience is required</li>
  <li> Government Program products is required</li>
  <li> Prior management experience is preferred</li>
  <li> Managed care or other healthcare related experience is preferred</li>
 </ul>
 <div></div>
 <div>
   Competencies, Knowledge and Skills:
 </div>
 <ul>
  <li> Strong familiarity with government-funded healthcare programs, including Medicaid, Marketplace, and Medicare, and the compliance standards imposed upon First Tier, Downstream and Related (FDR) entities</li>
  <li> Familiarity with Healthcare operations and/or clinical concepts, practices and procedures is preferred</li>
  <li> Data analysis ability to produce meaningful insight and drive appropriate action</li>
  <li> Demonstrated understanding of compliance and regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid)</li>
  <li> Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement</li>
  <li> Proven ability to effectively manage work through prioritization, preparing, effective scheduling, leveraging resources and maintaining focus</li>
  <li> Demonstrated professional communication skills, to include proper grammar usage, document structure, and business writing to audiences including but not limited to internal leadership at all levels, internal and external legal counsel, Corporate Compliance, State and Federal Regulators</li>
  <li> Strong decision making and problem-solving skills</li>
  <li> Demonstrated success in working in a matrixed environment</li>
  <li> Detail orientated with focus on maintaining accurate information in tools as required</li>
  <li> Effective active listening and critical thinking skills</li>
  <li> Time management skills including creation and maintenance of project timelines</li>
  <li> Advanced level experience in Microsoft Word, Excel and PowerPoint</li>
 </ul>
 <div></div>
 <div>
   Licensure and Certification:
 </div>
 <ul>
  <li> Compliance designation preferred</li>
 </ul>
 <div></div>
 <div>
   Working Conditions:
 </div>
 <ul>
  <li> General office environment; may be required to sit or stand for extended periods of time</li>
 </ul>
 <div>
   Compensation Range:
 </div> $90,500.00 - $158,400.00
 <div>
   CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
 </div>
 <div></div>
 <div>
   Compensation Type (hourly/salary):
 </div> Salary
 <div></div>
 <div>
   Organization Level Competencies
 </div>
 <ul>
  <li>
   <div>
     Create an Inclusive Environment
   </div></li>
  <li>
   <div>
     Cultivate Partnerships
   </div></li>
  <li>
   <div>
     Develop Self and Others
   </div></li>
  <li>
   <div>
     Drive Execution
   </div></li>
  <li>
   <div>
     Influence Others
   </div></li>
  <li>
   <div>
     Pursue Personal Excellence
   </div></li>
  <li>
   <div>
     Understand the Business
   </div></li>
 </ul>
 <div></div>
 <div>
  <br> This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.
 </div>
</div>

CareSource

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