Compliance Program Consultant IV at MEDICA PAIN MANAGEMENT

St. Louis, Missouri, United States -

Full Time

Start Date

Immediate

Expiry Date

27 Aug, 26

Salary

152300.0

Posted On

29 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Compliance Review, Regulatory Interpretation, Governance Process Management, SOP Development, Healthcare Compliance, Materials Review, Risk Assessment, Process Improvement, Monitoring and Reporting, CMS Regulations, Medicare Knowledge, Internal Auditing

Industry

Insurance

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. Administers an assigned Compliance Program by providing subject matter expertise and consultation to ensure compliance with State & Federal laws, regulations and mandates. Designs and incorporates processes and internal regulations to ensure compliance standards within the organization. Performs other duties as assigned. Key Accountabilities * Materials Compliance & Review * Lead compliance review of materials across all lines of business, including member, provider, broker and public-facing communications. * Ensure materials adhere to applicable regulatory requirements, internal policies and established compliance standards. * Interpret complex and evolving regulatory requirements and apply them consistently across materials. * Interpret complex and evolving regulatory requirements and apply them consistently across materials. * Serve as escalation point for complex, high-risk or ambiguous materials determinations. * Materials Governance & Process Management * Design and maintain materials review workflows and governance processes, including intake, review, approval and documentation standards. * Develop and document standard operating procedures (SOPs) to support consistent and compliant materials review practices. * Create and maintain job aids and training materials to support efficient and consistent execution of materials review processes by team members and business partners. * Monitoring, Reporting & Program Support * Monitor materials review activities and outcomes to ensure ongoing compliance with regulatory requirements, internal standards and established review processes. * Maintain and update materials tracking tools, logs and repositories to ensure complete and accurate documentation of review decisions and approvals. * Provide program support through participation in special projects, process improvement initiatives and cross-functional compliance efforts. Required Qualifications * Bachelor's degree or equivalent experience in related field * 7+ years of work experience beyond degree Preferred Qualifications * Strong knowledge of Medicare, CMS, and other healthcare regulatory requirements * Ability to interpret and apply complex regulatory guidance to materials * Experience with materials review, approval and governance processes * Experience developing workflows, SOPs or process improvements This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE. The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees. The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law. Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

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Responsibilities

Administers a Compliance Program by providing subject matter expertise to ensure adherence to State and Federal laws. Leads the review of member and provider communications and designs governance workflows and standard operating procedures.