Miami, Florida, United States · On-site
Pay: $120,000.00 per year Job description: SUMMARY The Compliance and Risk Manager is responsible for overseeing the organization’s enterprise-wide compliance and risk management programs, ensuring adherence to federal, …
Skills: Regulatory Compliance, Risk Management, Internal Auditing, Health Plan Audit Response, Risk Assessment
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Oversees enterprise-wide compliance and risk management programs for clinical and nonclinical benefit programs. Leads internal and external audits, manages risk assessments, and supervises the Fraud, Waste, Abuse, and Grievances teams.
Requires a Bachelor's degree in Business, Healthcare Administration, or a related field with 3-7 years of experience in compliance or regulatory affairs. Knowledge of HIPAA, CMS, and OIG frameworks is essential, and CPHC or CHC certification is preferred.
Pay: $120,000.00 per year
Job description:
The Compliance and Risk Manager is responsible for overseeing the organization’s enterprise-wide compliance and risk management programs, ensuring adherence to federal, state, and health plan requirements, as well as internal policies and industry standards. This role manages the full compliance framework for both clinical and nonclinical benefit programs—including Non-Emergency Medical Transportation (NEMT), Podiatry, Acupuncture, Chiropractic, Therapy, Optometry, Ophthalmology, and additional specialty care services.
The Compliance and Risk Manager conduct internal audits, leads external and health plan audit responses, manages risk assessments, and partners with cross functional teams to strengthen organizational integrity, operational excellence, and regulatory compliance.
Benefits:
Work Location: In person
Our integrated specialty benefits lowers your costs, increases your quality, and enhances your member experience.
Alivi Health, a tech-enabled healthcare company, is a fully delegated benefit manager for clinical and non-clinical provider networks, including Non-Emergency Medical Transportation (NEMT). By integrating clinical and non-clinical member benefits, Alivi's healthcare foundation brings a unique set of core competencies that effectively remove barriers to care and positively impact the path of care. As the only healthcare company that has developed a NEMT benefit management solution, it was a natural outgrowth to serving Medicaid and Medicare requirements through a unique care coordinator model. Outside of NEMT, Alivi Health also provides end-to-end utilization management programs for many specialty clinical benefits such as Physical Therapy, Occupational Therapy, Speech Therapy, ABA Therapy, Vision, and others. At Alivi Health, our clinically integrated approach to delivering care gives us a distinct advantage in addressing care gaps and improving adherence.
Offices: 5775 Blue Lagoon Dr, Suite 450, Miami, Florida 33126, US
Our integrated specialty benefits lowers your costs, increases your quality, and enhances your member experience.
Alivi Health, a tech-enabled healthcare company, is a fully delegated benefit manager for clinical and non-clinical provider networks, including Non-Emergency Medical Transportation (NEMT). By integrating clinical and non-clinical member benefits, Alivi's healthcare foundation brings a unique set of core competencies that effectively remove barriers to care and positively impact the path of care. As the only healthcare company that has developed a NEMT benefit management solution, it was a natural outgrowth to serving Medicaid and Medicare requirements through a unique care coordinator model. Outside of NEMT, Alivi Health also provides end-to-end utilization management programs for many specialty clinical benefits such as Physical Therapy, Occupational Therapy, Speech Therapy, ABA Therapy, Vision, and others. At Alivi Health, our clinically integrated approach to delivering care gives us a distinct advantage in addressing care gaps and improving adherence.
Offices: 5775 Blue Lagoon Dr, Suite 450, Miami, Florida 33126, US
