Sr. Compliance Specialist - Care Management Programs

About the role

Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.

Responsibilities

• Serve as the primary compliance liaison for Care Management and Utilization Management operations, providing strategic guidance and oversight to ensure adherence to applicable regulatory and accreditation requirements.
• Interpret, assess, and operationalize regulatory standards, including CMS Medicare Advantage and Managed Care requirements, NCQA and URAC accreditation standards, Utilization Review and Utilization Management regulations, and 42 CFR Part 2 requirements, as applicable.
• Oversee and support the organization’s multi-state Utilization Management licensing program by tracking licensing requirements across applicable jurisdictions, coordinating license applications and renewals, maintaining supporting documentation, and partnering with operational leaders to ensure ongoing compliance with licensing conditions and regulatory obligations.
• Provide compliance guidance and subject matter expertise related to clinical workflows, operational processes, policy development, and system implementations impacting Care operations.
• Support the full lifecycle management of Care-related policies, standard operating procedures, and associated documentation.
• Maintain accurate and organized documentation to support compliance activities, regulatory inquiries, audits, and accreditation requirements.

Requirements

• Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or a related field.
• 5+ years of experience in healthcare compliance, regulatory affairs, clinical operations, or a related healthcare environment.
• Demonstrated experience supporting Utilization Management, Care Management, and/or Disease Management programs.
• Working knowledge of CMS regulatory frameworks and managed care compliance requirements.
• Experience with NCQA and/or URAC accreditation standards and related operational readiness activities.
• Strong understanding of multi-state healthcare regulatory and compliance environments.

Qualifications

• Experience managing or supporting multi-state Utilization Management licensure programs.
• Clinical background, such as Registered Nurse (RN) or equivalent clinical experience.
• Knowledge of 42 CFR Part 2 requirements and related privacy regulations.
• Experience operating within a Business Associate environment.

Skills

• Excellent communication and interpersonal skills.
• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities and deadlines.
• Proficiency in Microsoft Office Suite.

Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous Paid Time Off to include vacation, sick leave, and paid holidays
• Employee Assistance Program that includes professional counseling, referrals, and additional services
• Paid maternity and paternity leave
• Pet insurance
• Employee discounts on phone plans, car rentals and computers
• Community giveback opportunities, including paid time off for philanthropic endeavors

Pay

Competitive salary commensurate with experience.

Schedule

Full-time, remote position.