[Hiring] Manager Medicare Compliance @St. Joseph Hospital & Medical Center
Role Description
The Medicare Compliance Officer (MCO) is responsible for developing, implementing, and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities for Mercy Care Plan, managed by Aetna, a CVS Company. This role ensures adherence to all applicable federal and state regulations and CMS requirements, safeguarding the integrity and compliance of Plan operations.
• Maintain day-to-day operational alignment with the Mercy Care Medicare team.
• Hold direct reporting accountability to the Chief Executive Officer (CEO) and the Audit and Compliance Committee of the Mercy Care Plan Board of Directors.
• Provide formal reports to the Board of Directors, CEO, and Compliance Committee at least quarterly, detailing:
• Status of Mercy Care Plan’s Medicare Compliance Program implementation.
• Identification and resolution of compliance issues.
• Oversight and audit activities.
• Oversee the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program, including:
• Program design.
• Content creation.
• Distribution.
• Tracking.
• Ongoing maintenance to ensure full compliance with regulatory and organizational standards.
• Develop and implement programs that promote a culture of integrity by encouraging reporting of suspected fraud, waste, abuse, or other misconduct.
• Respond promptly to reports of potential Medicare fraud, waste, or abuse (FWA), including:
• Coordinating internal investigations.
• Developing appropriate corrective or disciplinary actions when necessary.
• Maintain the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU).
• Exercise flexibility in designing and managing internal investigations and implementing corrective measures.
• Coordinate with the Plan’s Human Resources department to ensure thorough screening of the DHHS OIG and GSA exclusion lists for all employees, officers, directors, managers, and contracted entities.
Qualifications
• Bachelors or an equivalent combination of directly related work experience and/or education.
• Five (5) years of experience that demonstrates solid Medicare compliance program development, operation, and administration responsibilities.
Requirements
• Registered Nurse: AZ (preferred).
• Strong business acumen and healthcare industry knowledge.
Apply tot his job
Apply To this Job
The Medicare Compliance Officer (MCO) is responsible for developing, implementing, and overseeing the compliance program for Medicare Advantage (Part C) and Medicare Part D activities for Mercy Care Plan, managed by Aetna, a CVS Company. This role ensures adherence to all applicable federal and state regulations and CMS requirements, safeguarding the integrity and compliance of Plan operations.
• Maintain day-to-day operational alignment with the Mercy Care Medicare team.
• Hold direct reporting accountability to the Chief Executive Officer (CEO) and the Audit and Compliance Committee of the Mercy Care Plan Board of Directors.
• Provide formal reports to the Board of Directors, CEO, and Compliance Committee at least quarterly, detailing:
• Status of Mercy Care Plan’s Medicare Compliance Program implementation.
• Identification and resolution of compliance issues.
• Oversight and audit activities.
• Oversee the development and administration of the Board of Directors’ annual Code of Conduct and compliance training program, including:
• Program design.
• Content creation.
• Distribution.
• Tracking.
• Ongoing maintenance to ensure full compliance with regulatory and organizational standards.
• Develop and implement programs that promote a culture of integrity by encouraging reporting of suspected fraud, waste, abuse, or other misconduct.
• Respond promptly to reports of potential Medicare fraud, waste, or abuse (FWA), including:
• Coordinating internal investigations.
• Developing appropriate corrective or disciplinary actions when necessary.
• Maintain the FWA reporting mechanism and collaborate closely with the Internal Audit Department and the Special Investigations Unit (SIU).
• Exercise flexibility in designing and managing internal investigations and implementing corrective measures.
• Coordinate with the Plan’s Human Resources department to ensure thorough screening of the DHHS OIG and GSA exclusion lists for all employees, officers, directors, managers, and contracted entities.
Qualifications
• Bachelors or an equivalent combination of directly related work experience and/or education.
• Five (5) years of experience that demonstrates solid Medicare compliance program development, operation, and administration responsibilities.
Requirements
• Registered Nurse: AZ (preferred).
• Strong business acumen and healthcare industry knowledge.
Apply tot his job
Apply To this Job