Lead Compliance. Strengthen Quality. Elevate Performance.
Are you an experienced Utilization Management (UM) compliance leader who thrives in a fast‑paced, mission‑driven environment? Do you enjoy building audit frameworks, collaborating across departments, and ensuring regulatory excellence? LIBERTY Dental Plan is seeking a Manager, UM Compliance & Audit to oversee the full spectrum of UM compliance, audit, reporting, and training activities.
In this highly visible leadership role, you will ensure our UM programs meet federal and state regulatory requirements, accreditation standards, and contractual obligations—directly impacting quality, service delivery, and organizational performance.
What You’ll Do
You will lead a comprehensive UM compliance and audit program across all lines of business:
- Oversee the UM Compliance & Audit program end‑to‑end.
- Develop and lead the annual UM compliance risk assessment, maintaining the risk register, testing plan, and workplan.
- Coordinate with the Enterprise Compliance Team on new laws and program requirements.
- Translate regulatory updates into UM process changes, workflows, and training.
- Maintain a comprehensive documentation repository for UM policies, audits, training, SLAs, and corrective actions.
- Lead and manage internal, client, and external UM audits, including corrective action plan (CAP) development and monitoring.
- Serve as the subject matter expert for UM template letters (e.g., Integrated Denial Notices, Notice of Action Letters).
- Prepare and deliver UM performance metric reports to internal committees and leadership.
- Manage the quality and execution of all UM client reporting.
- Ensure adherence to regulatory and accreditation standards, including state UM laws, TATs, HIPAA, Medicaid Managed Care rules, CMS MA guidelines, and URAC/NCQA requirements.
- Provide day‑to‑day leadership for UM compliance, reporting, and training teams.
- Conduct performance management, coaching, and training for team members.
- Develop, maintain, and train Policy Explanation Codes (PECs) to support regulatory accuracy.
- Collaborate with Internal Audit and UM Management to identify training needs and develop effective learning materials.
- Support special initiatives, departmental improvements, and ad hoc projects.
What You Bring
We’re looking for a seasoned UM compliance leader with the following:
- Bachelor’s Degree in Healthcare Administration, Compliance, or related field.
- Minimum 6 years of UM compliance and leadership experience in dental or medical insurance.
- At least 3 years of hands‑on experience with UM audits and compliance programs.
- Strong knowledge of Medicaid Managed Care and Medicare Advantage UM requirements.
- Experience working with NCQA, CMS, and URAC standards and readiness reviews.
- Proven ability to design, execute, and refine audit programs.
- Excellent organizational, analytical, and writing skills.
- Strong presentation skills for internal and external audiences, including executives.
- Expert proficiency with Excel and audit data analysis tools.
- Thorough understanding of UM processes (e.g., prior auth, medical necessity, coding, billing).
- Demonstrated leadership, coaching, and team‑building abilities.
- Strong conflict management skills and the ability to drive strategic direction.
- Proficiency with Microsoft Office (Word, Teams, Outlook, PowerPoint).
- Ability to work independently in a compliance‑driven environment.
Who You Are
You are a leader who:
- Excels in structured, compliance‑focused environments.
- Communicates with clarity and confidence.
- Is skilled at simplifying complex regulatory requirements.
- Thrives in managing audits, systems, and high‑stakes workflows.
- Energizes teams through change and continuous improvement.
Why LIBERTY Dental Plan
At LIBERTY, you’ll join an organization where:
- Compliance and quality are core commitments.
- People and teamwork matter.
- You can directly impact service quality and regulatory success.
- Your leadership helps protect members, providers, and partners nationwide.
You’ll have the opportunity to shape processes, strengthen operational excellence, and build a high-performing UM compliance team.
Work Environment
- Professional and collaborative environment.
- Work involves structured documentation, audit coordination, and cross‑functional collaboration.
- Requires attention to detail and the ability to manage multiple priorities simultaneously.
Ready to Lead with Purpose?
Join LIBERTY Dental Plan and play a critical role in elevating compliance, enhancing quality, and supporting members nationwide.
