Senior Manager, Quality Assurance and Compliance - Health Plan Operations

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. 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.

The Job:
The Senior Manager of Quality Assurance and Compliance - Health Plan Operations is responsible for establishing and maturing an effective quality and compliance program across Operational areas, specifically Claims, Grievances and Appeals, Payment Configuration, Billing, Enrollment, etc. This includes evaluating operational controls, guidelines, tools and processes for monitoring, reviewing audits to meet accuracy, timeliness and contractual obligations, and enhancing operational processes.

This role serves as the second line of defense for the organization, ensuring adherence to regulations and maintaining high quality standards in operations.

You Will:
- Develop and implement a quality assurance program, reviewing audits to meet accuracy, timeliness and contractual obligations, and enhancing operational processes.
- Partner with Operations leadership to design and develop an effective Quality Assurance and Compliance program, gaining alignment on methodology, audit approach, KPIs, standards and issue resolution process.
- Manage quality and compliance reporting, coordinating accurate and timely submission of data, including audit readiness and documentation standards for Operations.
- Collaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfaction.
- Monitor and communicate performance trends, track and analyze KPIs, and share actionable insights with senior leadership.
- Establish effective governance framework including Audit the Auditor mechanism.
- Lead a team of quality assurance and compliance professionals, mentoring and fostering positive team culture.
- Partner with operational leadership to review findings, develop corrective action plans, and remediate identified issues to the root cause.
- Monitor industry trends, regulatory changes and current events to ensure team remains informed.

Your Qualifications:
- Bachelor's Degree required. Graduate or Advanced Degree or equivalent experience preferred.
- Audit Certification preferred.
- 5 years of related QA and compliance operations experience with Medicare and Medicaid across Operational areas (Claims, Grievances and Appeals, Payment Configuration, Billing, Enrollment, etc.)
- 3+ years' management experience in healthcare environment, preferably Medicare Advantage.
- 8+ years of progressive experience in healthcare or health plan operations.
- Experience managing Quality Assurance and/or Operations Audit team.
- Strong working knowledge of CMS and state regulations and operational implications.

What's in it for you?
- Base salary range: $125,400 to $181,419 per year
- Work Mode - Partially Remote
- An annual employee bonus program
- Robust Wellness Program
- Generous paid-time-off (PTO)
- Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
- Excellent 401(k) Retirement Saving Plan with employer match and contribution
- Tuition reimbursement

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. A background check is required.