Sr. Manager, Quality Assurance and Compliance

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.

SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.

Job Description:

The Senior Manager of Quality Assurance and Compliance is responsible for establishing and maturing an effective quality and compliance program across Operational areas. This includes evaluating operational controls, guidelines, tools and processes for monitoring, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes. This role oversees serves as the second line of defense for the organization ensuring the organization is adhering to regulations and maintain high quality standard in operations. This function plays a vital role in ensuring the accuracy, timeliness, and efficiency of operations processing and maintaining compliance with regulatory and operational requirements.

You Will

Responsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processes.

Partner with Ops leadership to design and develop an effective Quality Assurance and Compliance program gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process

Manage quality and Compliance reporting. Coordinate accurate and timely submission of data, including audit readiness and documentation standards for Operations

Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction.

Monitor and communicate performance trends track and analyze key performance indicators (KPIs). Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocation.

Establish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and compliance.

Lead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goals

Identifying trend and areas of opportunity for process improvements and additional training Work closely with operations leadership to review finding, develop action plans and remediate issues

Partner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop process

Monitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and procedures.

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your Qualifications

Bachelor's Degree required. Graduate or Advanced Degree or equivalent experience preferred.

Audit Certification preferred

5 years of related experience QA and compliance operations experience with Medicare and Medicaid

3+ years' management experience in healthcare environment, preferably Medicare Advantage

8+years of progressive experience in healthcare operations

Experience managing Quality Assurance and/or Operations audit team

Experience working with AI or other machine learning tools to assist with streamlining QA processes

Deep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievances

Proven success leading quality and compliance in a matrixed environment

Strong working knowledge of CMS and state regulations and operational implications

Leadership - Skilled to develops others

Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances

Strategic Mindset - Formulates strategy and maps steps to achieve strategic goals

Business Insight - In-Depth understanding of the business

What's in it for you?

• Base salary range: $125,400 to $181,419 per year
• Internal title - Sr. Mgr Care Quality Ops
• Work Mode - Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)