Manager Medicare Compliance
Company: CommonSpirit Health
Location: Phoenix
Posted on: March 26, 2026
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Job Description:
The Medicare Compliance Officer (MCO) is responsible for
developing, implementing, and overseeing the compliance program for
Medicare Advantage (Part C) and Medicare Part D activities for
Mercy Care Plan, managed by Aetna, a CVS Company. This role ensures
adherence to all applicable federal and state regulations and CMS
requirements, safeguarding the integrity and compliance of Plan
operations. Reporting Structure: This position will maintain
day-to-day operational alignment with the Mercy Care Medicare team
while holding direct reporting accountability to the Chief
Executive Officer (CEO) and the Audit and Compliance Committee of
the Mercy Care Plan Board of Directors. • Provide formal reports to
the Board of Directors, CEO, and Compliance Committee at least
quarterly, and more frequently as needed, detailing the status of
Mercy Care Plan’s Medicare Compliance Program implementation,
identification and resolution of compliance issues, and oversight
and audit activities. • Oversee the development and administration
of the Board of Directors’ annual Code of Conduct and compliance
training program, including program design, content creation,
distribution, tracking, and ongoing maintenance to ensure full
compliance with regulatory and organizational standards. • Develop
and implement programs and mechanisms that promote a culture of
integrity by encouraging managers and employees to report suspected
fraud, waste, abuse, or other misconduct, ensuring confidentiality
and protection against retaliation. • Respond promptly to reports
of potential Medicare fraud, waste, or abuse, (FWA) including
coordinating internal investigations and developing appropriate
corrective or disciplinary actions when necessary. Maintain the FWA
reporting mechanism and collaborate closely with the Internal Audit
Department and the Special Investigations Unit (SIU), as
applicable. • Exercise flexibility in designing and managing
internal investigations (e.g., addressing suspected violations or
reported issues) and implementing resulting corrective measures,
such as policy enhancements and disciplinary actions to ensure
compliance and mitigate risk. • Coordinate with the Plan’s Human
Resources department (or equivalent) to ensure thorough screening
of the DHHS OIG and GSA exclusion lists for all employees,
officers, directors, managers, and contracted entities, including
first-tier, downstream, and related entities, confirming none are
listed on these exclusions. Job Requirements Required • Bachelors
Other or an equivalent combination of directly related
workexperience and/or education and • Five (5) years of experience
that demonstrates solid Medicare compliance program development,
operation and administration responsibilities Preferred •
Registered Nurse: AZ Knowledge Skills and Training: • Strong
Business acumen and healthcare industry Located conveniently in the
heart of Phoenix, Arizona,St. Josephs Hospital and Medical Center
is a 571-bed, not-for-profit hospital that provides a wide range of
health, social and support services. Founded in 1895 by the Sisters
of Mercy, St. Josephs was the first hospital in the Phoenix area.
More than 125 years later, St. Josephs remains dedicated to its
mission of caring for the poor and underserved. We are extremely
proud to be a nationally recognized center for quality quaternary
care, medical education and research. St. Josephs includes the
internationally renowned Barrow Neurological Institute, Norton
Thoracic Institute, Cancer Center at St. Josephs, Ivy Brain Tumor
Center, and St. Josephs Level I Trauma Center (which is verified by
the American College of Surgeons). The hospital is also a respected
center for high-risk obstetrics, neuro-rehabilitation, orthopedics,
and other medical services. St. Joseph’s is considered a
sought-after destination hospital for treating the most complex
cases from throughout the world. Every day, approximately 20
percent of the hospital’s patients have traveled from outside of
Arizona and the United States to seek treatment at St. Joseph’s.
U.S News & World Report routinely ranks St. Josephs among the top
hospitals in the United States for neurology and neurosurgery. In
addition, St. Josephs boasts the Creighton University School of
Medicine at St. Josephs, and a strategic alliance with Phoenix
Childrens Hospital. St. Josephs is consistently named an
outstanding place to work and one of Arizonas healthiest employers.
Come grow your career with one of Arizonas Most Admired Companies.
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our community we are proud to be a tobacco-free campus.
Keywords: CommonSpirit Health, Scottsdale , Manager Medicare Compliance, Healthcare , Phoenix, Arizona
