Compliance Manager

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member. 

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit http://www.admidacareny.orgfor more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Compliance Manager. Compensation will be commensurate with experience.

Position Summary:

The Compliance Manager will work collaboratively with the Senior Director, Compliance/Compliance Officer and the Assistant Director Compliance/Privacy Officer to ensure compliance with all Medicaid regulatory requirements as well as compliance with internal Amida Care policies, where applicable.

Responsibilities:

• Reviews the Monitoring Report and follow up for evidence of Monitoring with appropriate Business Units.
• Responsible for oversight of required regulatory reports and follow up for evidence.
• Assists with scrubbing and analyzing OMIG audit data and preparing initial draft response.
• Assists with Provider Investigative Report data gathering and input in HCS system.
• Assists with FWA tasks and other functions as needed.
• Responsible for tracking distributed Regulatory Requirements and responsible for getting status updates from appropriate business units.
• Assists with the preparation of materials for Article 44/49 full operational and targeted surveys.
• Assists with research regarding current or pending regulatory requirements as needed.
• Assists Sr. Director Compliance/Compliance Officer with Mental Health Parity meeting preparation and follows up on regulatory requirement/items.
• Tracks and monitors required follow-up with Vendor Management staff regarding identified vendor compliance issues.
• Assists with obtaining information for education and training materials.
• Provides assistance with regulatory inquiries from business areas.
• Assists with internal audits as needed.
• Assists with report preparation for Compliance Committee meetings and BOD meetings.
• Assists with PolicyStat tasks. 
• Performs other duties as assigned.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms.  We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.  

EDUCATION REQUIRED

• Bachelor’s Degree or equivalent combination of education and relevant work experience.

EXPERIENCES AND/OR SKILLS REQUIRED

• Five (5) years’ experience in the field of Healthcare Compliance.
• General knowledge of Medicaid Managed Care.
• Efficient with MS Word, Excel, PowerPoint, Office.
• Exhibits ability to work independently with diligence.
• Exhibits a strong commitment to the integrity and effectiveness of the Compliance Department.
• Demonstrates ability to work collaboratively and effectively with all areas of the Company.
• Demonstrates interpersonal and verbal communication skills.
• Demonstrates ability to research facts regarding Compliance issues and incidents.
• Demonstrates understanding and sensitivity to multi-cultural values, beliefs and attitudes of both internal and external contacts.
• Demonstrates appropriate behavior in line with the Company’s mission, vision and values.