Clinical Innovation & Implementation, Program Director, Clinical Oversight and Audits

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Program Director, Clinical Oversight and Audits to join #TeamMVP. If you have a passion for data-driven decisions, regulatory compliance and efficiency and effectiveness this is the opportunity for you.

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
• Competitive compensation and comprehensive benefits focused on well-being
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York

Qualifications you'll bring:

• Licensed Practical Nurse (LPN) or Registered Nurse (RN) required.
• Minimum of 5-7 years' experience in the health insurance or related industry with proven experience in compliance, regulatory oversight, and clinical operations management
• Knowledge of DSNP Medicare Operations and regulatory requirements.
• Knowledge of LTSS & MAP Operations and regulatory requirements.
• Experience in developing and tracking compliance metrics.
• Ability to lead and participate in committees and provide compliance guidance.
• Curiosity to foster innovation and pave the way for growth
• Humility to play as a team
• Commitment to being the difference for our customers in every interaction

Your key responsibilities:

• Responsible for ensuring compliance with DSNP, LTSS and MAP contract obligations.
• Maintaining relationships with government agencies and influencing departmental strategy.
• This role requires an LPN or RN and involves making decisions on complex issues, exercising considerable latitude in determining objectives and approaches, and serving as a subject matter expert on DSNP Medicare Operations, MAP and LTSS.
• This position focuses on assessing the effectiveness of care management programs, monitoring compliance with Medicare and Medicaid regulations, conducting audits of clinical processes and documentation, and driving continuous improvement with the DSNP, MAP & LTSS programs, including delegated and non-delegated vendors and partners.
• This role is ideal for a dynamic and proactive individual with a strong background in clinical oversight and compliance, committed to maintaining a 100% compliant program, serving the underserved and improving healthcare outcomes through effective management and strategic planning.
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Where you'll be:

Hybrid, NYS

Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.

We do not request current or historical salary information from candidates.
MVP's Inclusion Statement
At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.

MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.

To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at hr@mvphealthcare.com.

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