At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Job Description

A bit about this role:

As the Director of Compliance for Devoted Health, you will be responsible for the team that supports our First Tier, Downstream and Related Entities. This means working across many operational teams as it pertains to First Tier, Downstream and Related Entities (FDRs) and Part D. Our FDRs support us in many different ways such as- PBM services, claims processing, call center, UM, supplemental benefits, translation services, etc. You will be responsible for owning risk assessments, managing audit work plans, conducting audits, developing audit tools, tracking potential compliance issues, issuing Corrective Action Plan (CAPs), overseeing oversight and monitoring Standard Operating Procedures of our FDRs and owning Compliance oversight and monitoring of the Medicare business as it pertains to our FDRs. In addition, you will be responsible to support operational areas within Devoted in your role.

Your Responsibilities and Impact will include:

• Own all processes as it pertains to our FDRs (FDR Determination process, FDR Risk Assessment, FDR Audit Plan, FDR Attestation process, FDR CPE, etc.) and ensure that there is appropriate oversight and monitoring being conducted of our FDRs which includes developing relationships with FDR Business Owners to ensure that FDRs are meeting regulatory requirements and contractual obligations

• Conduct internal audit based on audit schedule with successful completion of both the FDR Risk Assessment and FDR Audit Plan

• Analyze, research, develop, write, edit, review and distribute policy and procedure documents according to the company’s standards and CMS requirements

• Prepares reports by collecting, analyzing, and summarizing information

• Regulatory Communications support for all areas that fall under your scope; research regulations by reviewing regulatory guidance distributed from CMS and the states and other sources of information

• Support Federal and State audits and regulatory requirements as needed
  

Required skills and experience:

• 7-10 years of relevant business and or compliance experience, including a minimum of 5 years of relevant work experience with direct knowledge of CMS Medicare regulations and compliance programs for Medicare Advantage (MA), Medicare Advantage Prescription Drug (MAPD), and/or Prescription Drug Plans (PDP)

• Strong leadership and interpersonal skills with ability to work with a diverse group of people internally across the organization and externally, the ultimate team player

• Ability to determine business needs and develop processes that will support those business needs, maximizing efficiencies; the ability to make decisions and support implementation of new processes

• Develop, implement, track progress, and report on Compliance objectives, projects, timelines, and deliverables for the compliance program.

• Auditing experience on internal business areas and external vendors (FDRs)

• The ability to roll up your sleeves and do the actual work

Desired skills and experience:

• Proven experience in managing compliance programs within the Medicare Advantage sector, particularly with CMS regulations and audit processes

• Certified in Healthcare Compliance (CHC)

#LI-DS1
#LI-Remote

Salary Range: $165,000-$190,000

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered may depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.