Medicare Compliance Director

Job Summary

A company is looking for a Director of Operational Oversight (Medicare/Duals) to manage the CMS Complaints Tracking Module life cycle and ensure compliance.

Key Responsibilities

• Run audits to ensure CTM cases are logged and resolved within CMS timelines
• Integrate CTM insights into operations related to appeals, grievances, enrollment, and claims
• Validate vendor performance in handling CTM complaints according to standards

Required Qualifications

• Bachelor's degree in Health Administration, Business, Information Systems, or a related field (advanced degree preferred)
• 7+ years of experience managing Medicare CTM, appeals & grievances, or related compliance functions
• Deep knowledge of Medicare regulations affecting complaints and grievances
• Experience with downstream domains such as Enrollment, Claims, and Pharmacy
• Proven ability to close process gaps and implement improvements in a matrixed environment