Clinical Compliance Manager

Position: Clinical Compliance Manager

The Clinical Compliance Manager assists in developing and maintaining Monogram Health's Compliance Program, performs compliance oversight activities, provides compliance guidance, and works closely with the Learning & Development department on compliance-related training matters.

The Clinical Compliance Manager will report directly to the Senior Director, Compliance.

Roles and Responsibilities

• Oversees, administers, and implements various aspects of the Compliance Program.
• Performs compliance oversight activities, such as monitoring and audits, to evaluate compliance with regulatory (e.g., Centers for Medicare & Medicaid Services requirements) and contract requirements.
• Leads and/or support compliance risk assessment and work plan activities.
• Leads and/or supports external oversight inquiries and activities (e.g., external audits, annual attestations, etc.).
• Provides guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language.
• Assists in the development and maintenance of an effective compliance training program, including appropriate introductory training for new employees and ongoing training for all employees, working closely with the Learning and Development department.
• Works closely with operational departments to ensure policies are developed and updated to comply with regulatory and contract requirements. Ensures policies are distributed and accessible to applicable employees.
• Coordinates with Human Resources, Credentialing, and the IT departments to obtain and upload all Monogram Health employee, contractor, and vendor information monthly for routine exclusion and sanction monitoring, preclusion monitoring, and licensure monitoring. Works with Compliance Management, Credentialing, and/or Human Resources to investigate and document findings.
• Prepares compliance presentations and reports, such as incident and training metrics as requested.
• Conducts compliance-related special projects and research.
• Conducts inquiries and investigations into concerns received through the company's Compliance and Ethics Helpline or directly to the Compliance Department as assigned. Manages related tracking and reporting as directed.
• Works with leadership and staff to maintain an ethical and compliant culture that aligns with Monogram Health's Core Values of Honesty, Compassion, Mastery, Togetherness, Creativity, and Thriftiness.
• Conducts other duties as assigned by Compliance Management.

Position Requirements

• Bachelor's degree in related field or equivalent experience.
• Registered Nurse (RN) with active, unencumbered license
• Extensive knowledge of Medicare and Medicaid compliance programs.
• 5+ years Medicare Managed Care experience required, ideally with expertise in Special Needs Plan Model of Care (SNP MOC) requirements.
• 3+ years of experience in a leadership role required.
• Certification in Healthcare Compliance (CHC) strongly preferred.