Qureos Mentor

Versant Health

Manager, Compliance & Audits
 
Manager, Compliance & Audits
 
Who are we?
 
Versant Health is one of the nation’s leading administrators of managed vision care, serving millions of our clients’ members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthy eyes and vision.
 
As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.
 
See how you can make a difference with the support of strong leadership and a team environment.
 
See Everything, Be Anything™.
 
What are we looking for?
 
Versant Health is seeking an experienced and dynamic Manager, Compliance, and Audits_ Provider Network to oversee and lead provider network regulatory activities and audits. This key role will ensure that the provider network adheres to all federal, state, accreditation, and regulatory requirements. You will be responsible for managing audits, corrective actions, regulatory compliance, and reporting while working closely with internal and external stakeholders. This position requires strategic oversight, audit execution, and close collaboration with the Network Operations team, while being flexible with less than 25% travel annually.
 
Where you will have an impact
 
Regulatory Compliance & Audits: 
Oversee and manage compliance with all federal, state, and accreditation requirements related to provider networks, including delegated audits, corrective actions, and reporting.
 
Manage and coordinate SOC 1 Control Audits, including audit performance, measurements, remediations, and reporting to leadership.
 
Directly responsible for leading health plan and client audits, presenting audit outcomes, and managing corrective action plans (CAPs).
 
Policy and Procedure Management: 
Lead the creation, review, and maintenance of policies and procedures for Network Development activities to ensure alignment with federal, state, and accreditation requirements.
 
Work closely with the Network Development team to implement corrective actions and manage the necessary updates to operational policies and procedures.
 
Project and Stakeholder Management: 
Partner with internal teams, including Regulatory Compliance, Claims, Call Centers, Utilization Management, and other business functions to drive the implementation of regulatory changes.
 
Guide the organization through regulatory compliance processes, ensuring that new regulations are understood and properly implemented within the network’s operations.
 
Facilitate cross-functional collaboration to determine scope and resources required to implement changes, ensuring alignment with organizational goals.
 
Support the development of implementation plans for regulatory changes, ensuring policies, processes, and controls meet compliance standards.
 
Audit Reporting and Analytics: 
Generate and distribute compliance reports and audit findings to senior management. Provide trend analysis and recommendations for continuous improvement.
 
Assist in reporting to external auditors and regulatory bodies, ensuring timely and accurate submission of required documentation.
 
Leadership & Team Development: 
Provide training and guidance to internal teams on regulatory changes, compliance requirements, and audit processes.
 
Act as a subject matter expert, offering insights and support to Network Development and Regulatory Compliance teams.
 
What’s necessary to do the job?
 
Bachelor’s degree in business, healthcare administration, or a related field
 
Minimum of 5-7 years of experience in provider network management, compliance, audits, or regulatory affairs, with specific experience in healthcare or insurance sectors.
 
Deep knowledge of healthcare regulations, including HIPAA, CMS guidelines, and other federal and state laws impacting provider networks.
 
Experience conducting audits related to provider networks and managing corrective actions for compliance.
 
Proven expertise in managing SOC 1 control audits and delegations in health plans and client oversight audits.
 
Advanced knowledge of regulatory requirements and their impact on provider networks, with a focus on implementing compliance initiatives across multiple functional areas.
 
Strong project management skills, with experience in handling complex regulatory projects and working cross-functionally to ensure successful implementation.
 
Excellent communication and presentation skills, with the ability to interact with senior leadership, auditors, and external stakeholders.
 
Ability to generate reports, analyze trends, and make data-driven recommendations.
 
Detail-oriented with strong organizational and problem-solving abilities.
 
Certification in Healthcare Compliance (CHC) or related certifications is a plus.
 
Experience with Versant Health or similar healthcare organizations is beneficial.
 
Familiarity with compliance management tools and systems for regulatory oversight and audits.
 
HIPAA & Security Requirements
 
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program.
 
Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
 
Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.
 
The wage range for applicants for this position is ($80,000.00 to $85,000.00)
 
All incentives and benefits are subject to the applicable plan terms.

Manager, Compliance & Audits_Provider Network

Join Versant Health and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Versant Health

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Manager, Compliance & Audits_Provider Network