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Job description
Description
We are seeking an experienced Compliance Consultant to support the ongoing administration and enhancement of the Plan's Medicare Advantage Vendor Management Program. This role helps ensure compliance with CMS, DMHC, and other applicable regulatory requirements while strengthening vendor oversight, supporting operational effectiveness, and contributing to the successful development of new products and expanded services.
In this role, you will:
Coordinate vendor onboarding, classification, delegation assessments, contract management and ongoing oversight activities.
Review and maintain vendor documentation, contracts, inventories, compliance records, and related materials.
Monitor vendor and First-Tier, Downstream, and Related Entity (FDR) performance, identify potential risks, and support corrective actions and process improvements.
Ensure compliance with Medicare Advantage, CMS, DMHC, contractual, and organizational requirements.
Support the development, maintenance, and annual review of policies, procedures, and operational guidance.
Prepare and maintain regulatory, compliance, and operational reports, metrics, and supporting documentation.
Support internal and external audits, regulatory inquiries, and ongoing audit-readiness activities.
Investigate, document, and investigate potential compliance issues, incidents, and risks as appropriate.
Coordinate governance activities, including preparing committee materials and presentations, documenting meeting minutes, and tracking action items.
Maintain vendor management systems, SharePoint resources, and vendor-facing compliance materials, escalating when appropriate to remediate.
Provide guidance, training, and ongoing support to vendors, Vendor Relationship Owners (VROs), Accountable Owners (AOs), and other stakeholders.
Participate in special projects and initiatives supporting vendor management, compliance program objectives, system enhancements, regulatory requirements, new product offerings, service expansion, and operational improvements.
Salary Range: $88,900 - $190,300/annually
Qualifications
Required:
A Bachelor's Degree in Healthcare Administration, Business Administration, Public Health, Compliance, or related field; and/or equivalent combination of education and experience
5 or more years of experience in healthcare compliance, regulatory oversight, delegated entity oversight, vendor management, or related healthcare operations
Demonstrated thorough knowledge of Medicare Advantage and Part D regulatory requirements, including CMS guidance
Knowledgeable of healthcare compliance program elements, risk assessment, methodologies, and regulatory monitoring practices
Experience interpreting complex regulatory requirements and translating them into operational processes, controls, and procedures
Strong analytical and problem-solving skills to identify compliance risks, determine root causes, and recommend corrective actions
Experience conducting compliance reviews, monitoring activities, investigations or audit support functions
Utilizes strong project management and organizational skills to manage multiple priorities and regulatory deadlines
Communicates effectively in written and verbal format with all organization levels and external stakeholders
Proficiency preparing reports, presentations, documentation, policies, and compliance-related communications
Ability to build collaborative relationships with operational leaders, vendors, delegated entities, and regulatory stakeholders
Preferred:
Knowledge of delegated entity, vendor, subcontractor, and FDR oversight requirements within managed care environments
Possesses knowledge of California Department of Managed Health Care (DMHC) regulations applicable to Medicare Advantage plans
Familiarity with compliance management systems, reporting databases, SharePoint, and workflow management platforms
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Worksite address
los angeles, CA, 90079, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.