Compliance SDAG Manager
Apply NowCompany: InnovAge
Location: Denver, CO 80219
Description:
Responsibilities
The SDAG Compliance Manager is responsible for oversight of grievances, services determination requests (SDRs), appeals, and submission of enrollment denials and involuntary disenrollment of the assigned centers. This includes consistent compliance communication with staff; leadership for State and CMS complaints, management of internal compliance investigations as directed by Compliance Director.
Essential Functions and Work Responsibilities
Functional Category: Risk Management and Compliance Oversight
Estimated Percent of time Spent - 100%
Prepares requested reports by collecting, analyzing, and summarizing relevant information obtained through investigations, and other compliance activities.
Conducts oversight of grievances, services determination requests (SDRs), and appeals.
Provides compliance guidance and finalizes state and CMS submission for enrollment denials and involuntary disenrollment denials to be submitted/reviewed by Director of Compliance.
Assist in submitting ad hoc, monthly, quarterly, and annual deliverables to Federal and State regulators for the assigned centers.
Works with Director of Compliance to direct corrective action to reduce regulatory non-compliance.
Manages the participant internal and external appeals process to ensure compliance with PACE and State regulations.
Assists with policy and procedure development and maintenance.
Maintains current knowledge of regulatory guidance governing InnovAge entities and standards of compliance practice.
Work in collaboration with Center leadership to communicate ongoing areas for oversight and non-compliance concerns.
Performs other related duties as assigned.
Travel Requirements
Travel
Estimated Percent of time Spent - 10%
Travel between InnovAge worksites
Overnight travel out of state as needed.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
REQUIRED
Education
Bachelor's degree in related field or an equivalent combination of education and experience.
Licensure, Certification, Registration or Designation
Must have a state issued driver's license, personal transportation, good driving record and auto insurance as required by law.
Work Experience and Qualifications
Minimum four years of compliance related experience. Applied compliance and/or clinical risk management experience preferred.
Benefits
InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.
InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.
Applicants are considered until the position is filled.
Posted Salary Range
$86800-$112900
The SDAG Compliance Manager is responsible for oversight of grievances, services determination requests (SDRs), appeals, and submission of enrollment denials and involuntary disenrollment of the assigned centers. This includes consistent compliance communication with staff; leadership for State and CMS complaints, management of internal compliance investigations as directed by Compliance Director.
Essential Functions and Work Responsibilities
Functional Category: Risk Management and Compliance Oversight
Estimated Percent of time Spent - 100%
Prepares requested reports by collecting, analyzing, and summarizing relevant information obtained through investigations, and other compliance activities.
Conducts oversight of grievances, services determination requests (SDRs), and appeals.
Provides compliance guidance and finalizes state and CMS submission for enrollment denials and involuntary disenrollment denials to be submitted/reviewed by Director of Compliance.
Assist in submitting ad hoc, monthly, quarterly, and annual deliverables to Federal and State regulators for the assigned centers.
Works with Director of Compliance to direct corrective action to reduce regulatory non-compliance.
Manages the participant internal and external appeals process to ensure compliance with PACE and State regulations.
Assists with policy and procedure development and maintenance.
Maintains current knowledge of regulatory guidance governing InnovAge entities and standards of compliance practice.
Work in collaboration with Center leadership to communicate ongoing areas for oversight and non-compliance concerns.
Performs other related duties as assigned.
Travel Requirements
Travel
Estimated Percent of time Spent - 10%
Travel between InnovAge worksites
Overnight travel out of state as needed.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
REQUIRED
Education
Bachelor's degree in related field or an equivalent combination of education and experience.
Licensure, Certification, Registration or Designation
Must have a state issued driver's license, personal transportation, good driving record and auto insurance as required by law.
Work Experience and Qualifications
Minimum four years of compliance related experience. Applied compliance and/or clinical risk management experience preferred.
Benefits
InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.
InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays.
Applicants are considered until the position is filled.
Posted Salary Range
$86800-$112900