Verda Healthcare, Inc. has a contract with the Center for Medicare & Medicaid Services (CMS) and the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to ensuring that healthcare is easily and equitably accessible to all, especially in underserved communities. Our mission is to provide quality health and wellness services that empower individuals to lead healthier, more fulfilling lives. We are looking for a Senior Manager of Compliance to join our growing company with many internal opportunities.
Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare, Inc. is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.
Align your career goals with Verda Healthcare, Inc. and we will support you all the way.
Position Overview
The Senior Manager of Compliance will support the Medicare Compliance Program and ensure compliance with CMS and state regulatory requirements. This position reports to the Chief Compliance Officer and will assist in overseeing compliance operations, policies, training, risk management, internal and delegated auditing and monitoring, and will work closely with internal departments to promote a culture of compliance.
This position reports to the Chief Risk Officer.
Responsibilities
- Act as a key compliance advisor, providing regulatory guidance and ensuring adherence to Medicare compliance requirements.
- Assist in developing, maintaining, and revising compliance policies and procedures to support the organization’s regulatory responsibilities.
- Oversee and coordinate compliance training programs to ensure that employees and delegated entities understand their regulatory obligations.
- Lead internal and delegated entity auditing and monitoring efforts to ensure compliance with CMS regulations, contractual obligations, and internal policies.
- Implement and oversee risk management processes, identifying, assessing, and mitigating compliance risks.
- Conduct routine monitoring and internal audits, evaluating compliance effectiveness and identifying areas for improvement
- Support the development and implementation of corrective action plans in response to compliance concerns, audit findings, and identified risks.
- Collaborate with internal stakeholders and delegated entities to ensure compliance-related issues are effectively addressed.
- Assist in regulatory reporting and responses to external agencies, including CMS and state regulators.
- Promote compliance awareness through effective communication strategies, including the use of a compliance hotline and adherence to the Code of Conduct.
- Support compliance investigations, including root cause analysis and impact assessments, while working with Human Resources on necessary disciplinary actions.
- Stay informed on regulatory updates and changes in Medicare and Medicaid requirements, translating them into actionable guidance for the organization.
- This position requires daily in-office attendance to ensure effective collaboration and oversight of compliance activities.
Qualifications & Requirements
- Bachelor’s degree in healthcare, business, or a related field (Master’s or JD preferred).
- 5+ years of experience in Medicare Advantage and Prescription Drug Plan (Part D) compliance.
- 5+ years of regulatory/compliance experience, preferably within a managed care organization or health plan.
- 3+ years of leadership experience with direct responsibility for compliance functions.
- Experience with risk management, auditing, and monitoring, particularly related to internal processes and delegated entities.
- Certified in Health Care Compliance (CHC) or ability to obtain within 12 months of hire. • Strong knowledge of CMS regulations, Medicare Advantage, and Part D programs.
- Experience with compliance auditing, training, policy development, and corrective action implementation.
- Proficiency in Microsoft Office (Word, Excel, PowerPoint, SharePoint). • Excellent research, analytical, and communication skills.
- Ability to work on-site daily at our office location.
Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!
Job Type: Full-time
Benefits:
- 401(k)
- Paid time off
- Health insurance
- Dental Insurance
- Vision insurance
- Life insurance
Schedule:
- Full-time onsite **on-site attendance is required every day** • Monday – Friday (8-hour shifts)
- Occasional travel may be required for meetings and training sessions.
Ability to commute/relocate:
- Reliably commute or planning to relocate before starting work (Required)
PHYSICAL DEMANDS
Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.
*Other duties may be assigned in support of departmental goals.