Medicare Compliance Program Manager

About the role

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. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. 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. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

Responsibilities

• Provide independent, oversight of assigned components of the Medicare Advantage and Prescription Drug (MAPD) compliance program.
• Ensure that federal and state regulatory requirements are effectively implemented, monitored, and operating as intended to identify, mitigate, and escalate compliance risks across Medicare lines of business.
• Support alignment between CMS and California Department of Health Care Services (DHCS) requirements as part of an integrated Medicare and Medi-Cal oversight framework for Fully Integrated Dual Eligible Special Needs Plans (FIDESNPs).
• Develop compliance programs, provide oversight of program structure, standards, documentation, and effectiveness assessment.
• Analyze federal and state regulatory requirements in collaboration with Legal Affairs and operational partners to assess compliance impact, clarify expectations, and support business understanding of regulatory changes and updates.
• Lead regulatory interpretation and compliance impact assessments for new and evolving requirements; translate regulatory guidance into clear compliance expectations and advisory support for business areas.
• Partner with business areas by advising on regulatory strategy options, identifying compliance risks and considerations, and recommending approaches that support compliant implementation.
• Provide compliance advisory support to business areas related to corrective action planning and remediation efforts, including clarifying regulatory expectations and advising on remediation strategies.
• Identify, assess, and escalate compliance risks and emerging issues through established governance and leadership reporting channels.
• Recommend new or revised compliance policies, standards, and controls to support regulatory requirements and sustainable compliance in an evolving business environment, demonstrating the ability to lead through ambiguity.
• Provide compliance guidance and targeted education to assigned functional areas by contributing to training materials, presentations, and educational sessions that reinforce regulatory expectations, while maintaining independence from training administration and tracking.

Qualifications

• Bachelor's Degree or equivalent experience
• 3-5 years of related experience
• 2-3 years of leadership experience
• Regulatory Expertise - Strong knowledge of applicable federal and state Medicare regulatory requirements, with the ability to interpret guidance and apply it to compliance oversight, risk assessment, and advisory support.
• Analytical and Critical Thinking - Ability to analyze complex regulatory issues, assess compliance risk, evaluate impacts, and identify trends using data, documentation, and operational insights.
• Attention to Detail & Documentation - Demonstrated attention to detail to ensure accuracy, completeness, and audit ready documentation in compliance analyses, reporting, and governance materials.
• Effective Written & Verbal Communication - Ability to clearly and concisely communicate complex compliance requirements, risks, and recommendations to diverse audiences, including operational teams and senior leadership.
• Advisory & Consultative Skills - Ability to provide practical, risk based guidance and professional challenge to business partners while maintaining second line independence and avoiding operational execution.
• Organizational & Time Management Skills - Strong ability to manage multiple priorities, regulatory timelines, and competing demands in a dynamic, highly regulated environment.