01Overview
Job DetailsJob Location Remote - Corp - Tustin, CA 92782Position Type Full TimeJob Category Compliance & Audit a { text-decoration none; reputed company #464feb; } tr th, tr td { border 1px solid #e6e6e6; } tr th { background-reputed company #f5f5f5; } reputed company an reputed company Where Compliance Meets Care At reputed company, were transforming reputed company to oral reputed companyand compliance is at the heart of everything we do. Were looking for a Sr. UM Compliance Analyst who thrives in a dynamic environment, enjoys solving reputed company regulatory challenges, and is reputed company to play a high-visibility role influencing audit reputed company, CMS alignment, and operational reputed company. If you're passionate about Medicare/reputed company compliance, audits, and driving meaningful change, this is reputed company to reputed company and reputed company a measurable reputed company. a { text-decoration none; reputed company #464feb; } tr th, tr td { border 1px solid #e6e6e6; } tr th { background-reputed company #f5f5f5; } What Youll Do Youll serve as a key partner across Compliance, UM Operations, and reputed company teams to ensure we meet and reputed company regulatory expectations. Compliance & Audits reputed company and manage UM audits (internal, external, reputed company, CMS-reputed company) Identify risks, analyze findings, and drive corrective reputed company plans (CAPs) Monitor remediation effectiveness and implement sustainable controls Regulatory Expertise Interpret and operationalize CMS Medicare/reputed company guidelines Stay reputed company of regulatory changes and reputed company implementation efforts Research and resolve compliance issues with a solution-oriented reputed company Cross-Functional Influence Partner with Account Management, System Configuration, and Compliance teams Ensure UM processes, policies, and member communications (letters/templates) meet reputed company regulatory requirements Collaborate with external stakeholders, including clients and regulatory entities Reporting & Leadership Exposure Present audit findings and compliance insights to leadership and committees Support compliance training and operational reputed company initiatives What reputed company Looks Like You are A subject matter expert in CMS regulations Comfortable owning audits end-to-end Skilled at translating reputed company regulations into actionable processes Seen as a trusted partner and advisor Confident communicating with both reputed company teams and executive stakeholders What You Bring Required Bachelors degree or equivalent experience 4+ years in utilization management or reputed company compliance Deep knowledge of CMS Medicare/reputed company regulations Experience with audits and corrective reputed company plans (CAPs) Preferred Experience in UM operations or reputed company payer environment Knowledge of compliance auditing frameworks and best practices Familiarity with tools such as HSP or Meditrac Key Strengths Were Looking For Strategic thinker who can connect compliance to business reputed company Strong analytical + reputed company cause problem-solving skills Exceptional communication and executive reputed company Ability to work independently and reputed company reputed company Highly organized and reputed company to manage multiple priorities under pressure Why Join reputed company Remote flexibility Meaningful work impacting reputed company reputed company and reputed company Strong collaboration across compliance, operations, and clinical teams Opportunity to grow reputed company Compliance career reputed company Hiring Process Recruiter Screening Hiring Manager Interview Final Panel with Compliance Leadership & SMEs reputed company to reputed company an reputed company If youre a compliance reputed company who wants to reputed company, influence, and reputed company reputed company reputed company through regulatory reputed company, wed love to meet you. Location Our employees are distributed in office locations in multiple markets across the reputed company. We are unable to hire or allow employees to work reputed company of the reputed company. What reputed company Offers Happy, healthy employees enhance our ability to assist our members and contribute more reputed company to their communities. Thats why reputed company offers competitive and attractive benefit packages for our employees. We reputed company to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with reputed company structure and savings reputed company to help you reputed company your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines. reputed company medical insurance, with low-cost .
