Manager - GOV0000O
DESCRIPTION/RESPONSIBILITIES:
Departmental Description:
Responsible for departmental leadership for Michigan contracts, joint venture contracts, and client services for Medicare Advantage business, including strategic analyzing, planning, and implementation. Provide ongoing oversight of federal and state contract requirements. This department is also conducting monitoring reviews and advisory services for Medicaid and the Federal Employee Program. This manager will develop an Annual Work Plan of proposed monitoring reviews based on a risk analysis and interviews with various levels of management. The manager may participate in the presentation of the Work Plan to the Corporate Compliance Committees and Audit Committees of the Boards for BCBSM, BCN, Emergent Holdings, and each joint venture.
* Ensure that day to day business unit operations align with organizational objectives.
* Create and maintain corporate and compliance policies including obtaining the appropriate level of approval.
* Create and maintain a Medicare Advantage compliance risk assessment and annual plan for all joint venture contracts and client services.
* Execute monitoring and auditing projects including external audit coordination for joint ventures and clients.
* Proactively participate in various oversight and working committees, acting as the compliance SME to ensure compliance with applicable MA requirements and contractual obligations.
* Prepare reports and present compliance information to the audit and compliance committees throughout the year.
* Remain current and knowledgeable of industry and compliance trends and the changing requirements related to MA.
* Advise senior executive leadership on industry and regulatory requirements and quickly conduct research, when needed, to ensure compliance.
* Align business processes across all MA business units to ensure compliance and effective procedures.
Description:
Responsible for planning, organizing and managing an assigned business unit. Operate within broad objectives to ensure optimum utilization of resources; adapt business unit plans and priorities to address resource and operational challenges. Evaluate policies, procedures and business unit goals to make decisions and solve problems.
* Manage activities of a department including, but not limited to planning, problem solving, staff development and communication.
* Manage the evaluation of new and existing business processes to identify areas of opportunity and execute on business unit objectives, supporting continuous improvement.
* Lead, direct, evaluate and develop the work of assigned employees.
* Responsible for special projects, programs and initiatives to ensure successful delivery of business outcomes.
* Provide effective and efficient solutions to complex business problems
* Ensure that day to day business unit operations align with organizational objectives.
All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.