Federal Program Compliance Senior Manager - Medicare Part C- Remote

Role Summary

The Medicare Part C Compliance Senior Manager is responsible for the design, implementation, and ongoing execution of the Medicare compliance program while upholding the overall Cigna Compliance Plan. This Senior Manager will ensure operational compliance with all regulatory requirements and standards relative to Medicare Part C medical operations.  This individual will lead a team of compliance professions who ensure our business partners (i) understand and implement all Medicare regulatory requirements, (ii) remediate issues timely and effectively, and (iii) understand any compliance/regulatory risks to effectuate mitigation strategies.  This individual must promote strong relationships with key business and compliance leaders by endorsing an enterprise culture of compliance and serving as a trusted business advisor. Additionally, this role will assist in Medicare related external audits as well as liaise with Legal, Product, and Operational staff.

Responsibilities

• Report to the Legal Compliance Director of Medicare Business Support (MBS).
• Lead a team of compliance professionals responsible for financial, operational, and business support.
• Develop and implement a continual improvement program to enhance oversight of Medicare Part C operations and clinical and improve business performance.
• Collaborate with various members of the Compliance, Product, and Operational organizations.
• Ensure compliance of First Tier, Downstream and Related entities (FDR) with Medicare and state rules and regulations as applicable and provide oversight of the FDR program.
• Utilize subject matter expertise to ensure Medicare regulations have been implemented timely and accurately both internally and by pertinent FDRs.
• Inform both the Director of Medicare Business Support and the Medicare Compliance Officer of Part C trends, risks, or issues that should be considered for self-disclosure to regulating bodies.
• Collaborate with internal Compliance and Legal leadership to determine Cigna’s compliance policies as it relates to corresponding Medicare programs.
• Leverage an enterprise mindset while collaborating with internal Legal and Compliance leadership.
• Create and execute a development program for all staff ensuring they continue to grow their skillset and expand their knowledge enabling their career progression.
• Develop strong working relationships with internal parties to ensure open lines of communication and timely responses to compliance concerns, inquiries, or deliverables.
• Perform ongoing compliance/regulatory risk assessment of all related Medicare Part C functions.
• Leverage resources to mitigate the highest risks identified via the risk assessment.
• Perform other duties as assigned.

Qualifications 

• Previous Medicare compliance and operational industry experience required.
• Health plan experience required, involvement with Part C operations is needed to be considered.
• 5+ years of Medicare program …