Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals.If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

This position is responsible for managing a team of Regulatory Performance Management (RPM) sales and marketing subject matter experts (SME) which includes the management of the marketing review process and the sales allegation process.The Manager will own the Sales Allegation and Marketing Review processes and make recommendations to management when needed as new regulatory guidance is released.In addition, they will also manage the compliance process and workflows for marketing material submissions and supervise Sales Allegation investigations.

 Responsibilities:

• Responsible to formalize and execute a robust agent oversight strategy to ensure compliance with Medicare Advantage regulations and the MCMG’s. This includes monitoring and reporting activities to evaluate compliance with applicable laws, regulations, sub-regulatory guidance and internal policies.
• Manages a team of Regulatory Performance Management SMEs responsible for the review, approval, and submission of all prospective/member communications and marketing materials.This includes managing Statement of Work with vendor(s) and assisting in material review during peak times.The Manager also oversees the RPM team that conducts investigations of agent-related allegations and ensures appropriate resolution of allegations, including any related corrective actions needed.
• Maintains comprehensive compliance documentation, including policies and procedures, to support ongoing compliance efforts.
• Maintains up-to-date knowledge of Medicare Advantage compliance rules and industry best practices to proactively identify compliance risk and recommend mitigation strategies.
• Collaborates with internal stakeholders, includes sales, marketing, legal and compliance teams to develop and communicate agent oversight policies and procedures.
• Oversees the RPM Agent Oversight Committee bi-monthly meetings.
• Ensures appropriate monthly reporting on Sales Allegation volume, type and disposition into RPM’s Online Monitoring Tool (OMT).
• Maintains deep knowledge and understanding of CMS MCMG’s to assist RPM team and key stakeholders in making interpretations related to CMS guidance.
• Provides feedback and mentor associates to drive towards more efficient processes and managing staff production and functions for Marketing Review.
• Provides ongoing support and training to the appropriate business areas on new and existing Medicare Advantage rules and promote a culture of compliance within the organization.

QUALIFICATIONS

• Bachelor’s degree in business administration, marketing, healthcare administration or a related field or equivalent work experience.
• Minimum of 8 years progressive related experience
• Proven work experience with a focus on Medicare Advantage compliance or sales and marketing/agent oversight/product.
• Knowledge of Medicare Advantage regulations, guidelines, and requirements.
• Exceptional analytical and problem-solving skills with keen attention to detail.
• Excellent communication and interpersonal skills with the ability to effectively collaborate with cross-functional teams and external partners.
• Strong leadership abilities and the capacity to drive change and foster a culture of compliance within the organization.
• Ability to manage multiple projects simultaneously and meet deadlines in a fast-paced and highly regulated environment.