Compl Oversight Spec Sr - Non Clin

Participates in the oversight of WellCare's and/or its delegated subcontractor's corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Responsibilities include conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with WellCare's contractual and regulatory requirements; collaborates with business owners and/or delegated vendors to drive remediation and assist WellCare and delegated subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements. In addition, acts as a subject matter expert in the department and may be a mentor to staff and/or interns.

Essential Functions:
  • Educate, encourage, and assist those within the company and with the company’s delegated subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of Government-sponsored health care programs.
  • Support management in the development and maintenance of monitoring and auditing tools designed to evaluate internal and delegated subcontractor compliance with Government-sponsored health care program requirements, State Medicaid program annual work plans, and OIG and CMS work plans.
  • Communicate the importance of compliance and the Compliance Program to health plan staff and/or delegated subcontractors, which includes promoting increased awareness of the Corporate Ethics and Compliance Program; understanding of new and existing compliance issues and related policies and procedures; and importance of implementing and maintaining effective oversight and monitoring activities.
  • Assist with the development, initiation, and maintenance and revision of Compliance Program policies, procedures, and practices for the general operation of the Program.
  • Assist in the assessment of new and amended Government-sponsored health care program contracts and requirements
  • Assist Markets (local), Shared Services (corporate), and/or delegated subcontracts in the identification and assessment of compliance risks. Serve as a compliance advisor to business units and delegated subcontractors.
  • Evaluate the effectiveness of Market (local), Shared Services (corporate), and/or delegated subcontractor compliance programs and related policies and procedures designed to promote legal and ethical compliance. Provide guidance and support to department associates.
  • Prepare accurate and timely formal written reports on oversight and monitoring activity findings and recommendations and ensure workpapers are properly prepared in accordance with WellCare and departmental standards, including sufficient evidentiary material exists to support oversight and monitoring activity findings.
  • Collaborate with other departments and/or delegated subcontractors to direct compliance issues to appropriate channels for research and resolution.
  • Review and evaluate the status and effectiveness of corrective action plans and provide comprehensive follow up to stakeholders, Senior Management, Market Compliance Oversight Committees, and/or the Audit, Finance, and Regulatory Compliance Committee of the Board of Directors.
  • Lead and participate in special projects as needed, including training.
  • Perform other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in a related field or an additional 4 years of Managed Care/Health Insurance experience
    Candidate Experience:
    • Required 4 years of experience in Managed Care/Health Insurance
    • Required 1 year of experience in project oversight type role with demonstrated ability to drive implementation and influence others
    • Required 1 year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations
    • Required 1 year of experience in State Medicaid or Federal managed care compliance
    Candidate Skills:
    • Advanced Ability to represent the company with external constituents
    • Advanced Knowledge of community, state and federal laws and resources
    • Intermediate Demonstrated project management skills
    • Intermediate Demonstrated ability to deal with confidential information
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Demonstrated analytical skills
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Intermediate Demonstrated written communication skills
    • Intermediate Ability to work independently
    • Intermediate Ability to influence internal and external constituents
    • Intermediate Other analytical skills and an understanding of operational processes and regulatory requirements
    • Intermediate Other understands the regulatory framework within which the company operates
    • Intermediate Other develop partnerships, teamwork and good working relationships
    • Intermediate Other self-motivation, initiative, practical learning skills, enthusiasm
    • Ability to multi-task
    Licenses and Certifications:
    A license in one of the following is required:
    • Preferred Other Certified in HealthCare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), or Certified Fraud Examiner (CFE)
    Technical Skills:
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft PowerPoint
    • Required Intermediate Microsoft Excel
    • Preferred Intermediate Microsoft Access
    • Preferred Intermediate Healthcare Management Systems (Generic)
    • Preferred Intermediate Other audit/compliance platforms

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. WellCare is a Fortune 500 company that employs nearly 9,000 associates across the country and was ranked a ''World's Most Admired Company'' in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.