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Part-Time Senior Consultant Special Needs Plan Model of Care (SNP-MOC)

Job Summary:

Responsible for providing subject matter expertise regarding Medicare Part C SNP-MOC requirements in order to effectively support our clients in projects, such as mock audits, program audit support, validation audits as well as operational assessments.

Essential Functions:

  • Subject matter expertise and thorough knowledge of CMS SNP-MOC requirements for MOC under Chapter 5 of the MMCM, as well as program audit requirements for SNP MOC.
  • Provides SME support to the Clients’ SNP-MOC team to help the Client reach compliance with program policies and procedures, industry standards, and regulatory requirements
  • Provide SME support and advice regarding integration and coordination of SNP-MOC services, working closely with the client’s business analytics staff, managerial staff, and other operational areas responsible for SNP MOC activities.
  • Ability to review, interpret and implement state and federal guidance.
  • Perform CMS SNP MOC mock audits to assess compliance with guidance.
  • Support the client in creation, implementation and validation of corrective action plans.
  • Ability to work in a team environment, collaboratively with the Project Manager and other members of the team.
  • Ability to work with Clients in an effective manner to achieve project success and Client satisfaction.
  • Ability to be flexible to meet the needs of the Client based on the project.
  • Ability to manage and meet timelines, providing a quality work product.
  • Adhere to established corporate policies and procedures.
  • Perform other duties, as necessary, to meet corporate objectives
  • Travel as required

Qualifications:

  • Bachelor’s degree (RN preferred) and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.)
  • Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required.
  • Experience with Medicare and/or Medicaid standards required.
  • Advanced degree or certification in audit, pharmacy or compliance discipline preferred.
  • Must have strong verbal and written communication skills.
  • Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
  • Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.

 


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Part-Time Senior Consultant Special Needs Plan Model of Care (SNP-MOC)

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