State Licensed Clinical Compliance Manager

Job Summary

A company is looking for a Clinical Compliance Program Manager.

Key Responsibilities:

• Ensure compliance with CMS, NCQA, and other regulatory standards through performance measurement and outcomes activities
• Assist in the development and enforcement of policies aligned with Utilization Management and Compliance requirements
• Conduct compliance audits and prepare for regulatory, accreditation, and contractual audits

Required Qualifications:

• At least 4-6 years of relevant work experience
• Advanced working knowledge of CMS UM audits with 2-3 years of compliance experience
• 1-2 years of experience implementing CMS final rule changes
• Bachelor's Degree or equivalent work experience