Remote Sr. Manager, Quality Assurance and Compliance Health Plan Operations

Note: The job is a remote job and is open to candidates in USA. SCAN is a nonprofit health organization dedicated to improving care for older adults. 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, ensuring adherence to regulations and maintaining high-quality standards in operations.ResponsibilitiesResponsible for developing and implementing a quality assurance program, reviewing audits meet accuracy, timeless and contractual obligations, and enhancing operational processesPartner 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 processManage quality and Compliance reporting. Coordinate accurate and timely submission of data, including audit readiness and documentation standards for OperationsCollaborate with operational partners to align workflows, address barriers to performance, and implement initiatives to enhance operations and member satisfactionMonitor and communicate performance trends track and analyze key performance indicators (KPIs). Share actionable insights and recommendations with senior leadership to inform strategic planning and resource allocationEstablish effective governance framework to include Audit the Auditor mechanism to achieve organizational goals related to quality and complianceLead a team of quality assurance and compliance professionals mentoring, fostering positive team culture, promote leadership growth, encourage innovation, and continuous learning to achieve team or individual goalsIdentifying trend and areas of opportunity for process improvements and additional training Work closely with operations leadership to review finding, develop action plans and remediate issuesPartner with operational leadership to review finding, develop corrective action plans, and remediate identified issues to the root cause ensuring a closed loop processMonitor industry trends, regulatory changes and current events to ensure team remains informed and adapts to evolving policies and proceduresSupervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)We seek Rebels who are curious about AI and its power to transform how we operate and serve our membersActively support the achievement of SCANs Vision and GoalsOther duties as assignedSkillsBachelor's Degree required5 years of related experience QA and compliance operations experience with Medicare and Medicaid across Operational areas, specifically Claims, Grievances and Appeals, Payment Configuration, Billing, Enrollment, etc3+ years' management experience in healthcare environment, preferably Medicare Advantage8+ years of progressive experience in healthcare or health plan operationsExperience managing Quality Assurance and/or Operations Audit teamExperience working with AI or other machine learning tools to assist with streamlining QA processesDeep experience in operational areas such as claims, configuration, provider data, benefits, enrollment, appeals and grievancesProven success leading quality and compliance in a matrixed environmentStrong working knowledge of CMS and state regulations and operational implicationsLeadership - Skilled to develop othersProblem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstancesStrategic Mindset - Formulates strategy and maps steps to achieve strategic goalsBusiness Insight - In-Depth understanding of the businessStrong verbal and written communication skills and interpersonal skillsStrong analytical and critical thinking skillsDetail oriented, organized and strong time management skillsGraduate or Advanced Degree or equivalent experience preferredAudit Certification preferredBenefitsWork Mode - Partially RemoteAn annual employee bonus programRobust Wellness ProgramGenerous paid-time-off (PTO)Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holidayExcellent 401(k) Retirement Saving Plan with employer match and contributionRobust employee recognition programTuition reimbursementAn opportunity to become part of a team that makes a difference to our members and our community every day!Company OverviewAbout SCAN Keeping Seniors Healthy and Independentthats been our mission for more than 40 years. It was founded in 1977, and is headquartered in Long Beach, California, USA, with a workforce of 1001-5000 employees. Its website is https://www.thescangroup.org/.Company H1B SponsorshipSCAN has a track record of offering H1B sponsorships, with 3 in 2026, 5 in 2025, 3 in 2024, 6 in 2023, 6 in 2022, 5 in 2021, 6 in 2020. Please note that this does not guarantee sponsorship for this specific role. Apply To this Job .