Job Details

Program Manager, Medicaid Compliance

Company name

Kaiser Permanente

Organization Type

Public Interest

Job Type


Years of Experience

Min 5 yrs required


Rockville, MD

Date Last Verified

Jan 30,2018

Posted on

Nov 15,2017
Practice Area
Litigation >> Litigation - Insurance
Health Care >> Health Care
Insurance Defense >> Insurance Defense
Apply for this job
Your Email:
Upload Resume:

48 hits


Program Manager, Medicaid Compliance Description: Reponsible for developing and maintaining a Regional Medicaid Compliance Program designed to partner closely with the Medicaid Office and MAPMG to advise regional staff on contract and regulatory Medicaid requirements in Maryland, Virginia and the District of Columbia; develop functional procedures compliant with state Medicaid program requirements; monitor performance with Medicaid compliance requirements; and conduct education and training of appropriate personnel on state programs compliance issues, as needed. Will serve as the point person to facilitate external and internal Medicaid Regulatory Audits. Audit preparation, faciliatating the collection of pre-audit materials, and working with the Medicaid Operations Team and other internal business partners to develop, report and monitor any associated action plans responding to audit recommendations or other issues of non-compliance. Responsible for maintaining an informational reporting relationship and information exchange with the National Compliance Office. Monitor and evaluate regional compliance with state programs contract(s) and Medicaid regulatory requirements. Advise regional departments and staff on Medicaid requirements related to regulatory Medicaid requirements in Maryland, Virginia and (eventually) the District of Columbia. Develop agreement among regional leaders and managers of key departments to provide oversight of compliance activities across all work teams and processes that affect state programs members of KPMAS. Review and oversee submission and negotiation for approval of all marketing materials. Work effectively with Health Plan and MAPMG leaders and labor partners to effectively provide compliance oversight of Medicaid program. Create and establish effective means of interdepartmental communication and coordination of state programs compliance contract issues and activities both directly and through the appropriate committee structure. Present state programs compliance and regulatory issues at meetings with appropriate operations areas, and serve on appropriate compliance workgroups as directed by the VP, Regional Compliance Officer or Compliance Director. Participate on state contractors committees as appropriate. Participate on Medicaid workgroups or projects with the National Compliance Office. Interpret state and local Medicaid requirements for affected departments and assist departments in developing operational policies and procedures, specialized training and other functions to comply with state programs contract requirements, regulations, operational policy letters and others guidance. Communicate to organizational departments new or changing legislation and contract requirements. Assist the organization in accessing impact of the changes and provide compliance oversight for the implementation of new or revised regulatory requirements related to the Medicaid contracts. Work with operational teams to develop internal monitoring tools that evaluate compliance with Medicaid requirements. Review the results of internal monitoring and work with the operational areas to develop corrective actions when noncompliance is identified. Conduct risk assessments of operational processes and functions in order to prioritize where additional compliance review is warranted. Develop and conduct adhoc audits of processes to ensure compliance with contract requirements and internal policies and procedures. Coordinate preparations for state and local contract monitoring visits and for internal audits. Coordinate the development of corrective action plans and appropriate activities following an audit. Assure timely submission of corrective action plans to the state agencies and respond timely to other items, pertaining to audits from the state agencies. Serve as primary contact with State agency personnel for issues related to compliance with the Medicaid contracts. Other duties as assigned by the VP, Regional Compliance Officer or Director, Audit Readiness, Legislative and Product Compliance.

Qualification and Experience

Qualifications: Bachelor's Degree. JD Degree or Master's Degree. Professional certification in healthcare Compliance (CHC). 5+ years' experience in a health insurance product and/or health insurance regulatory setting required, with a strong preference for Medicaid requirements related to VA, MD and DC health care regulation and MCO requirements. 5+ years of experience in compliance. 3+ years experience working with Medicaid contract issues or similar requirements. 3+ years experience in interpreting statutes and regulations and working in a regulatory environment. 3+ years experience performing audits and/or preparing for and responding to regulatory audits by federal and state regulators. Demonstrated ability to interpret complex data. Demonstrated ability to effectively collaborate with executive and medical staffs, administration, department heads and other personnel, as well as external contacts. Demonstrates customer-focused services skills. Preferred: Experience with Virginia, Maryland and DC regulations, Medicaid, standards and MCO requirements. Strong financial background. Ability to interpret data and collaborate with teams. Demonstrated effective ability to work with executive and medical staffs, administration, department heads and other KPMAS personnel, as well as external contacts. Demonstrated ability to work independently and motivate people to achieve shared goals is required. Demonstrates clear organizational skills. Excellent written and verbal communication skills. Experience in education, training and oral presentation. Experience with PC, relevant applications, analytical and statistical skills. Project management skills. Skills in negotiation and conflict resolution. Demonstrates problem solving and decision making skills. Ability to manage complex report structure required. Project management skills. Demonstrated ability to manage multiple large complex priorities and projects and meet deadlines.

Additional info

Job Number: 605031

Company info

Hiring Coordinator
Kaiser Permanente
1396 Piccard Dr
Rockville, MD 20850

Similar Jobs:

Clinical Ethicist Senior Duties: Collaborate and evaluate with the Director to provide ethics consultations in support of safe and effective quality care. Develops, implements, maintains and evaluates ethics orientation and educa...
Claims Manager The candidate will be responsible within an assigned portion of the company system for managing all aspects of professional liability, general liability and workers compensation claims management. In addition each ...
State Policy Manager Duties: Reports to Director of Public Policy. Managing all aspects of state and local public policy work, including identifying priorities, developing and executing strategy, advocating for or against state...