Medicare Compliance Program Manager

Medicare Compliance Program Manager

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The purpose of the Medicare Compliance Program Manager role is to provide independent oversight of assigned components of the Medicare Advantage and Prescription Drug (MAPD) compliance program. The role ensures that federal and state regulatory requirements are effectively implemented, monitored, and operating as intended to identify, mitigate, and escalate compliance risks across Medicare lines of business.

The position works closely with operational and functional areas to provide regulatory guidance, challenge controls, and assess compliance effectiveness. For Fully Integrated Dual Eligible Special Needs Plans (FIDESNPs), the role supports alignment between CMS and California Department of Health Care Services (DHCS) requirements as part of an integrated Medicare and Medi-Cal oversight framework.

You will be accountable as the program owner for assigned Medicare compliance domains by developing compliance programs, providing oversight of program structure, standards, documentation, and effectiveness assessment. Key areas of compliance domains include: claims, grievance & appeals, Utilization Management, pharmacy, Medicare marketing (this list is not exhaustive).

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, and have a firm understanding of how the regulatory strategies impact the business.

Partnering 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 to business areas 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, demonstrating the ability to lead through ambiguity.

Provide compliance guidance and targeted education to assigned functional areas by contributing to training materials, presentations, and educational sessions that reinforce regulatory expectations, while maintaining independence from training administration and tracking.

Skilled in partnering with and building consensus with business units and stakeholders by facilitating information exchange, communicating regulatory considerations, and elevating risks or concerns as appropriate, while demonstrating a firm understanding of how the regulations impact business and operations.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your 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, including operational teams and senior leadership.
• Advisory & Consultative Skills- Ability to provide practical, risk based guidance and professional challenge to business partners while maintaining second line independence and avoiding operational execution.
• Organizational & Time Management Skills- Strong ability to manage multiple priorities, regulatory timelines, and competing demands in a dynamic, highly regulated environment.

What's in it for you?

• Base Pay Range: $92,400 to $133,671 annually
• Work Mode: Mostly Onsite (In the Long Beach, CA office Tuesdays and Wednesdays)
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO) along with 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities