Medicare Compliance Program Manager

Job Overview Founded in 1977 as the Senior Care Action Network (SCAN), the organization serves over 500,000 people across the Western United States. The Medicare Compliance Program Manager provides independent oversight of assigned components of the Medicare Advantage and Prescription Drug (MAPD) compliance program, ensuring federal and state regulatory requirements are effectively implemented, monitored, and operated to identify, mitigate, and escalate compliance risks across Medicare lines of business. Responsibilities Accountable as the program owner for assigned Medicare compliance domains (claims, grievance & appeals, utilization management, pharmacy, Medicare marketing, etc.) by developing compliance programs, providing oversight of program structure, standards, documentation, and effectiveness assessment. Analyze federal and state regulatory requirements in collaboration with Legal Affairs and operational partners to assess compliance impact, clarify expectations, and support business understanding of regulatory changes and updates. Lead regulatory interpretation and compliance impact assessments for new and evolving requirements; translate regulatory guidance into clear compliance expectations and advisory support for business areas. Provide regulatory leadership and partnership to cross‑functional project teams, including initiatives involving regulators, agencies, or external consultants, to inform regulatory strategy and risk considerations. Partner with business areas by advising on regulatory strategy options, identifying compliance risks and considerations, and recommending approaches that support compliant implementation. Provide compliance advisory support related to corrective action planning and remediation efforts, including clarifying regulatory expectations and advising on remediation strategies. Identify, assess, and escalate compliance risks and emerging issues through established governance and leadership reporting channels. Recommend new or revised compliance policies, standards, and controls to support regulatory requirements and sustainable compliance in an evolving business environment. Provide compliance guidance and targeted education to assigned functional areas by contributing to training materials, presentations, and educational sessions that reinforce regulatory expectations. Facilitate information exchange, communicate regulatory considerations, and elevate risks or concerns as appropriate, while demonstrating a firm understanding of how regulations impact business and operations. Actively support the achievement of SCAN’s Vision and Goals. Other duties as assigned. Qualifications Bachelor's Degree or equivalent experience. 3‑5 years of related experience. 2‑3 years of leadership experience. Regulatory Expertise: Strong knowledge of applicable federal and state Medicare regulatory requirements, with the ability to interpret guidance and apply it to compliance oversight, risk assessment, and advisory support. Analytical and Critical Thinking: Ability to analyze complex regulatory issues, assess compliance risk, evaluate impacts, and identify trends using data, documentation, and operational insights. Attention to Detail & Documentation: Demonstrated attention to detail to ensure accuracy, completeness, and audit‑ready documentation in compliance analyses, reporting, and governance materials. Effective Written & Verbal Communication: Ability to clearly and concisely communicate complex compliance requirements, risks, and recommendations to diverse audiences. Advisory & Consultative Skills: Ability to provide practical, risk‑based guidance and professional challenge to business partners while maintaining second line independence. Organizational & Time Management Skills: Strong ability to manage multiple priorities, regulatory timelines, and competing demands in a dynamic, highly regulated environment. Benefits Base Pay Range: $92,400 to $133,671 annually. Work Mode: Mostly onsite (at the Long Beach, CA office Tuesdays and Wednesdays). An annual employee bonus program. Robust wellness program. Generous paid‑time‑off (PTO) plus 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days. Excellent 401(k) retirement savings plan with employer match. Robust employee recognition program. Tuition reimbursement. Opportunity to become part of a team that makes a difference to our members and our community every day. Equal Employment Opportunity Scan is a proud Equal Employment Opportunity and affirmative action workplace. Individuals seeking employment will receive consideration without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, marital status, disability, protected veteran status, or any other status protected by law. A background check is required. #J-18808-Ljbffr GRP SCAN Group