Senior Compliance Specialist

Job Summary

Partnering with Care Management and Utilization Management teams, the full-time Senior Compliance Specialist will serve as the primary compliance resource for regulatory, accreditation, and licensing requirements impacting clinical operations in a remote environment.

Key responsibilities

• Provide strategic guidance and oversight to ensure adherence to regulatory and accreditation requirements for Care Management and Utilization Management operations
• Interpret and operationalize regulatory standards, including CMS regulations and NCQA/URAC accreditation standards
• Oversee the multi-state Utilization Management licensing program, ensuring compliance with licensing conditions and regulatory obligations

Required qualifications

• Bachelor's degree in Healthcare Administration, Nursing, Public Health, or a related field
• 5+ years of experience in healthcare compliance, regulatory affairs, or clinical operations
• Demonstrated experience with Utilization Management and Care Management programs
• Working knowledge of CMS regulatory frameworks and managed care compliance requirements
• Experience with NCQA and/or URAC accreditation standards