Managed Care Compliance Specialist – Managed Care

Join Cedars-Sinai Medical Center's Managed Care department in California as a Managed Care Compliance Specialist, where you'll ensure our organization operates with full regulatory compliance while safeguarding the integrity of our healthcare claims and operations.

About the Role

The Managed Care Compliance Specialist supports the design and execution of internal auditing and monitoring programs within Managed Care. You'll help ensure our operations meet all applicable federal and state requirements, including AB1455 and Medicare Claims Processing Guidelines, while identifying and mitigating compliance risks across our managed care functions.

What You'll Do

• Assist in developing and implementing audit and monitoring frameworks for Managed Care operations
• Review managed care documentation, claims processing, and related activities for regulatory adherence
• Conduct audits and quality assessments to identify compliance gaps and strengthen controls
• Analyze findings and develop actionable recommendations for compliance improvements
• Support ongoing surveillance of managed care processes to maintain regulatory adherence
• Collaborate with department leaders and cross-functional teams to resolve compliance issues
• Maintain comprehensive audit documentation, records, and compliance reports

What We're Looking For

• Knowledge of healthcare compliance regulations, Medicare guidelines, and California healthcare requirements
• Understanding of managed care operations or healthcare claims processing
• Meticulous attention to detail and ability to review complex healthcare documentation
• Strong organizational and documentation skills with the ability to track audit activities and findings
• Clear written and verbal communication skills to present compliance insights to stakeholders
• Proficiency with business software and healthcare management databases
• Bachelor's degree in healthcare administration, compliance, business, or related field, or equivalent professional experience

About Cedars-Sinai Medical Center

Cedars-Sinai Medical Center is a prominent academic medical center in California dedicated to delivering exceptional patient care, advancing medical research, and promoting healthcare innovation.

How to Apply

To apply, complete your application directly on this page, or you'll be redirected to the employer's application platform to finish submitting there.