Accountabilities:

Develop and implement audit methodologies and monitoring strategies to identify, prevent, and address compliance issues across Medicaid business partner operations.
Conduct comprehensive auditing and monitoring activities to evaluate operational processes and ensure adherence to applicable state and federal laws, regulations, and contractual requirements.
Identify compliance gaps, assess potential risks, and recommend appropriate corrective and preventive actions to strengthen internal controls.
Present audit and monitoring findings to business partners and senior Enterprise Compliance leaders, ensuring clear communication of identified issues and recommended solutions.
Oversee the development, implementation, and progress of corrective action plans, tracking identified issues through timely and effective resolution.
Review and analyze business documents, operational records, and supporting data to determine whether regulatory requirements are being adequately documented and fulfilled.
Research, interpret, and translate regulatory and contractual requirements into practical guidance for internal departments and external business partners.
Advise business units and stakeholders on the operational implications of regulatory changes and recommend appropriate adjustments to existing processes.
Provide ongoing compliance oversight and monitoring of Medicaid business operations to minimize organizational risk and maintain regulatory standards.
Support external audits by coordinating documentation, preparing relevant information, and assisting with responses to audit requests.
Coordinate compliance-related communications and interactions with regulatory authorities, ensuring accurate and timely information exchange.
Build and maintain effective working relationships with operational leaders, internal compliance teams, and external business partners.
Identify opportunities for process improvement and recommend enhancements to compliance procedures, monitoring frameworks, and reporting practices.
Provide backup support to other members of the Medicaid Regulatory Compliance team and undertake additional responsibilities as required.

Requirements

Bachelor's degree in a relevant discipline or related field.
At least 5 years of professional experience in regulatory law, compliance, auditing, risk management, managed care, or a related healthcare field.
Demonstrated experience working with regulatory agencies and understanding regulatory oversight processes.
Strong knowledge of regulations governing the healthcare industry, including the ability to interpret complex regulatory and contractual requirements.
Proven ability to analyze regulatory obligations and help business units understand their operational impact and implementation requirements.
Experience developing, executing, or supporting compliance monitoring and auditing activities.
Strong understanding of risk identification, internal controls, corrective action planning, and compliance improvement processes.
Excellent analytical and problem-solving abilities, with the capacity to evaluate complex situations, identify compliance gaps, and recommend effective solutions.
Exceptional written and verbal communication skills, including the ability to present findings and explain regulatory requirements to diverse stakeholders.
Strong attention to detail and the ability to review complex documentation and data accurately.
Excellent organizational and time-management skills, with the ability to manage multiple projects, competing priorities, and deadlines effectively.
Ability to work independently with minimal supervision, exercise sound judgment, and determine appropriate objectives and approaches to assigned responsibilities.
Strong interpersonal and relationship-building skills, with the ability to collaborate effectively with operational leaders, regulatory authorities, and external business partners.
A proactive and improvement-oriented mindset, with the ability to identify opportunities to strengthen processes and enhance compliance performance.

How Jobgether works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

#LI-CL1