Project Consultant
Emergent Holdings

SUMMARY:

Regulatory Oversight Project Consultants are responsible for leading processes and projects that ensure compliance oversight and ongoing monitoring of Blue Cross Blue Shield of Michigan (BCBSM) Medicare Advantage and Part D programs. This position's responsibilities include developing monitoring review processes to ensure compliance with CMS regulations for Medicare Advantage operations. This role develops and improves workflows and business processes to strengthen controls, mitigate risks, and improve quality and efficiency. Interface with external customers, including regulatory agencies and professional associations, internal customers and vendors to identify and/or analyze business problems and develop solutions is required.

RESPONSIBILITIES/TASKS:

• Develop and implement risk assessment and monitoring review processes to mitigate and/or remediate risk within the Medicare Advantage (MA) line of business
• Identify, analyze, and develop solutions to assist in the identification and mitigation of compliance risks and strengthen controls
• Track and manage corrective action plans to address identified compliance risks and deficiencies.
• Draft communications for executive leadership, CMS regulators, and internal departments
• Research, interpret, and understand CMS regulations and applicable laws
• Collect and review evidence from vendors (FDR) to support MA compliance requirements
• Chair and participate in focused project workgroups
• Interface with various departments, senior management, and individuals to provide expertise in compliance and regulatory issues and initiatives
• Represent leadership staff at meetings in their absence.
• May have supervisory responsibilities as required.
• Ensure expectations are developed, controlled, and executed in a timely manner.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION:

Bachelor's degree in business or a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

EXPERIENCE:

Five years' experience in a related field with demonstrated technical knowledge that provides the necessary skills, knowledge, and abilities. Leadership and/or analytical experience preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Excellent analytical, organizational, planning, and verbal and written communication skills.

Ability to analyze, consolidate, and report information to internal and external stakeholders.

Demonstrated proficiency in current industry standard computer applications and systems.

Significant creativity.

Ability to work independently, within a team environment, and with multiple priorities.

Proficient in current industry standard PC applications and systems (e.g., Access, Excel and Word).

Ability to work closely with the technical support team in understanding and resolving systems issues.

Ability to develop, implement, and monitor policies and procedures.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Travel is required.

PAY RANGE:

Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $62,100 and $104,000.

The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.

We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.

This job has expired.