Healthfirst

The Clinical Regulatory Compliance Audit Manager serves as a point of contact for all internal and external clinical audit requests; works interdepartmentally to monitor, review, develop, and submit responses as required; and identifies and remedies potential compliance violations. The Manager works collaboratively with leadership to support the timely execution of activities across Clinical Operations, Corporate Compliance, and Regulatory.

Duties and responsibilities: 

• Supports the efforts related to regulatory implementations, audit readiness activities, and audit support  
• Develops, implements, and monitors processes to manage routine clinical audits and ensure regulatory compliance 
• Advises departments on operational strategy to ensure alignment to compliance and regulatory requirements  
• Oversees development of business documentation and data repositories that supports requirements such as but not limited to business decision logs, data universes, etc. 
• Partners with key Healthfirst stakeholders such as but not limited to Legal, Regulatory, Compliance, Finance, and Pharmacy to identify, understand, and process audit deliverables 
• Responds to regulatory actions and audit inquiries timely and effectively 
• Identifies and recommends process improvements to better ensure compliance with regulations 
• Additional duties as required

Minimum Qualifications: 

• Bachelor’s degree from an accredited institution or equivalent work experience 
• Experience in the healthcare industry with knowledge of compliance and regulatory requirements 

Preferred Qualifications: 

• Advanced degree 
• Certifications such as PMP, Six Sigma or Lean 
• Previous history of working in a Medicare and Medicaid managed care environment with a focus on quality outcomes 
• Knowledge of CMS and/or New York State Department of Health (NYSDOH) regulations 
• Relevant prior experience such as experience working at a managed care health plan, pharmacy benefits management, delegated vendor, or healthcare regulatory compliance experience 
• Experience in supporting audits and regulatory requirements 
• Work experience with process improvement initiatives 
• Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team  
• Excellent time and project management, communication, critical/creative thinking, and problem-solving skills 
• Extensive stakeholder/leadership engagement, development, and training experience  
• Intermediate Outlook, Word, Excel, and PowerPoint skills including creating spreadsheets, pivot tables, queries, and formulas 

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775

• All Other Locations (within approved locations): $86,500 - $128,690

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.