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Program Manager, Medicaid Compliance
In this role, you will be responsible for developing and maintaining a Regional Medicaid Compliance Program designed to partner closely with the Kaiser Permanente Mid-Atlantic Medicaid Office and the Mid-Atlantic Permanente Medical Group to advise regional staff on contract and regulatory Medicaid requirements in Maryland, Virginia, and the District of Columbia. You will 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. You will also serve as the point person to facilitate external and internal Medicaid Regulatory Audits which 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, you will be responsible for maintaining an informational reporting relationship and information exchange with the National Compliance Office.
At least five years of experience in a health insurance product and/or health insurance regulatory setting, with a strong preference for Medicaid requirements related to Virginia, Maryland, and the District of Columbia health care regulation and MCO requirements
At least five years of experience in compliance
At least three years of experience working with Medicaid contract issues or similar requirements, interpreting statutes and regulations and working in a regulatory environment
At least three years of experience performing audits and/or preparing for and responding to regulatory audits by federal and state regulators
A bachelor’s degree
The ability to interpret complex data
The ability to effectively collaborate with executive and medical staffs, administration, department heads and other personnel, as well as external contacts
Demonstrated customer-focused services skills
The ability to work independently and motivate people to achieve shared goals
Demonstrated 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
The ability to manage complex report structure
Project management skills (Demonstrated ability to manage multiple large complex priorities and projects and meet deadlines)
Preferred Qualification Include:
Experience with Virginia, Maryland, and District of Columbia regulations, Medicaid, standards, and MCO requirements
Strong financial background
The ability to interpret data and collaborate with teams
Demonstrated effective ability to work with executive and medical staff, administration, department heads, and other Kaiser Permanente personnel, as well as external contacts
JD or master’s degree
Professional Certification in Healthcare Compliance (CHC)
For immediate consideration, please visit http://kp.org/careers for complete qualifications and job submission details, referencing job number 605031.
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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
This position supports Kaiser Permanente’s code of conduct and compliance by adhering to all laws and regulations, accreditation and licensure requirements, and internal policies and procedures.
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