AVP, Medicare Advantage C-SNP Compliance in Huntington Beach, California at Verda Healthcare Inc

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to

the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and

Arizona. Our mission is to ensure that underserved communities have access to health and wellness services,

and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for an AVP, Medicare Advantage C-SNP Compliance to join our growing company with many internal

opportunities.

Are you ready to join a company that is changing the face of health care across the nation?

Verda Healthcare plan is looking for people like you who value excellence, integrity, care and innovation. As

an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision

incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview

AVP, Medicare Advantage C-SNP Compliance is responsible for leading and overseeing compliance

with CMS Medicare Advantage, Chronic Condition Special Needs Plan (C-SNP), and applicable federal and

state regulatory requirements.

This position serves as a key compliance authority for the C-SNP program and is accountable for establishing

effective controls, monitoring operational performance, identifying regulatory risks, coordinating audits,

managing corrective actions, and ensuring that the organization can demonstrate compliance to CMS and

other regulators.

The Compliance Officer will work closely with Clinical, Operations, Quality, Utilization Management, Network,

Pharmacy, Member Services, Enrollment, Marketing, IT, Analytics, delegated entities, and executive

leadership to ensure that C-SNP requirements are consistently implemented and documented.

This position reports to Chief Compliance Officer/Chief Executive Officer.

Responsibilities:

1. C-SNP Regulatory Compliance

• Maintain comprehensive knowledge of CMS Medicare Advantage and C-SNP requirements.

• Monitor regulatory changes, CMS guidance, HPMS communications, audit protocols, and applicable

federal and state requirements.

• Translate regulatory requirements into operational policies, procedures, controls, workflows, and

measurable accountability.

• Ensure C-SNP operations remain aligned with the approved SNP Model of Care (MOC) and

applicable CMS requirements.

Medicare Advantage C-SNP Compliance Officer

• Maintain a centralized C-SNP compliance calendar and regulatory obligation inventory.

2. SNP Model of Care Compliance

• Oversee implementation and ongoing compliance with the organization's approved C-SNP Model of

Care.

• Monitor required processes involving:

o Health risk assessments

o Individualized care plans

o Interdisciplinary care teams

o Care coordination

o Beneficiary access and communication

o Transitions of care

o Provider engagement

o Care management

o Quality improvement

• Establish monitoring mechanisms to identify gaps in MOC implementation.

• Ensure deficiencies are documented, assigned, corrected, and validated.

3. CMS Audit and Regulatory Readiness

• Lead organizational readiness for CMS program audits, C-SNP audits, data validation, and other

regulatory reviews.

• Coordinate responses to CMS, state regulators, auditors, and other oversight organizations.

• Ensure audit evidence is accurate, complete, timely, and traceable to the applicable requirement.

• Establish audit response ownership across business units.

• Review audit findings before submission and ensure management understands potential compliance

implications.

• Track corrective actions through completion and validation.

4. Compliance Monitoring and Oversight

Develop and maintain an ongoing compliance monitoring program covering areas such as:

• Enrollment and eligibility

• C-SNP eligibility and qualifying conditions

• Member communications

• Marketing and sales

• Provider requirements

• Care management

• Utilization management

• Quality and Star Ratings

• HEDIS

• Medication management and pharmacy

• Claims and encounter data

• Risk adjustment/HCC activities

Medicare Advantage C-SNP Compliance Officer

• Grievances and appeals

• Access and availability

• Delegated entity performance

• Member rights and protections

• Fraud, Waste and Abuse

• Privacy and security

• Cultural and linguistic requirements

Prepare regular compliance reports identifying open issues, responsible owners, due dates, risk levels,

corrective actions, and escalation requirements.

5. Delegated Entity Compliance

Because Medicare Advantage operations may rely heavily on delegated providers and vendors, the

Compliance Officer will:

• Establish compliance requirements for delegated entities.

• Monitor delegated entities against contractual and regulatory obligations.

• Review delegated entity audit results, compliance reports, and performance metrics.

• Ensure appropriate oversight, documentation, and escalation of deficiencies.

• Coordinate corrective action plans when delegated entities fail to meet requirements.

• Maintain evidence demonstrating that the Plan is exercising appropriate oversight of delegated

functions.

6. Corrective Action and Issue Management

• Maintain a formal compliance issue and corrective action tracking process.

• Investigate identified compliance deficiencies and determine appropriate remediation.

• Assign accountable owners and measurable completion dates.

• Escalate overdue or high-risk issues to executive leadership and the Compliance Committee.

• Validate that corrective actions actually resolved the underlying issue rather than merely addressing

documentation.

• Maintain evidence supporting closure of compliance findings.

7. Policies, Procedures and Documentation

• Develop, review, and maintain compliance policies and procedures.

• Ensure policies accurately reflect current CMS requirements and operational practices.

• Identify discrepancies between written policies and actual business processes.

• Establish appropriate documentation standards to ensure the organization can demonstrate

compliance during an audit.

8. Training and Compliance Culture

• Develop and coordinate compliance training for employees, providers, delegated entities, and

applicable contractors.

Medicare Advantage C-SNP Compliance Officer

• Provide targeted training when regulatory changes or audit findings identify knowledge gaps.

• Promote a culture in which compliance ownership resides with the responsible business unit rather

than solely with the Compliance Department.

9. Reporting and Executive Governance

Provide regular reporting to executive leadership and applicable governance committees regarding:

• C-SNP compliance status

• Regulatory changes

• Open compliance risks

• CMS audit readiness

• MOC compliance

• Delegated entity performance

• Corrective action status

• Material incidents

• Overdue remediation

• Emerging regulatory risks

Immediately escalate significant compliance concerns that may expose the organization to regulatory action,

financial penalties, member harm, contractual consequences, or CMS sanctions.

Preferred Qualifications

• Experience working directly with CMS or CMS audit contractors.

• Experience with SNP Model of Care implementation and monitoring.

• Medicare Advantage compliance certification such as CHC, CHPC, CCEP, or equivalent.

Medicare Advantage C-SNP Compliance Officer

• Clinical background such as RN, LPN, social work, or healthcare management.

• Experience with CMS HPMS and Medicare Advantage regulatory communications.

• Experience with delegated medical groups, IPAs, MSOs, vendors, or other downstream entities.

• Experience in a Medicare Advantage health plan, particularly a startup or rapidly growing plan.

Professional Competencies

The successful candidate must demonstrate:

• Regulatory expertise: Understands Medicare Advantage and C-SNP requirements at an operational

level.

• Ownership: Personally drives compliance issues to resolution.

• Attention to detail: Can identify gaps between regulatory requirements, policy, documentation, and

actual practice.

• Audit readiness: Maintains continuous readiness rather than preparing only when an audit occurs.

• Cross-functional leadership: Can hold business units accountable without relying solely on formal

authority.

• Judgment: Recognizes when an issue requires immediate executive or regulatory escalation.

• Execution: Converts findings into measurable corrective actions and verifies completion.

• Documentation discipline: Ensures every material compliance requirement has an identifiable

owner, evidence, monitoring mechanism, and remediation process.

Key Performance Measures

Performance will be measured based on, among other factors:

• Timely identification and remediation of compliance deficiencies.

• C-SNP and Model of Care compliance.

• CMS audit readiness and audit performance.

• Timely completion and validation of corrective action plans.

• Regulatory reporting accuracy and timeliness.

• Delegated entity compliance and oversight.

• Closure of high-risk compliance issues.

• Accuracy and completeness of compliance documentation.

• Effectiveness of ongoing compliance monitoring.

• Timely escalation of material regulatory risks.

Accountability

This position is accountable for the C-SNP compliance framework, but individual business-unit leaders

remain accountable for compliance within their respective operational functions.

The Compliance Officer must have sufficient authority and access to escalate material compliance concerns

directly to executive leadership and the appropriate Compliance Committee or governing body.

The expectation is not simply to identify compliance problems. The expectation is to identify the

requirement, establish the control, assign the accountable owner, monitor performance, document

the evidence, drive remediation, and verify that the issue is actually resolved.

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment

Location: Corporate (Huntington Beach)

Compensation Range:

$160,000.00 – $190,000.00 annually

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if

available), and geographic location. This position may also be eligible for performance-based incentive

compensation and benefits.

Benefits:

• 401(k)

• Paid time off (vacation, holiday, sick leave)

• Health insurance

• Dental Insurance

• Vision insurance

• Life insurance

Schedule:

• Full-time onsite (100% in-office)

• Hours of operations: 9am – 6pm

• Standard business hours Monday to Friday/weekends as needed

• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or plan to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to

25-50 pounds.

*Other duties may be assigned in support of departmental goals