Manager UM Compliance and Audit

Liberty Dental Plan Careers•Tustin, CA

1d•Remote

About The Position

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.

Requirements

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.

Responsibilities

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.

Benefits

Competitive pay structure and savings options to help you reach your financial goals.
Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
100% employer-paid dental coverage for employees and eligible dependents.
Vision insurance with low-cost premiums for employee-only coverage and dependents.
Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
Flexible Spending Accounts for healthcare and dependent care expenses.
Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
Long-term disability coverage.
Expansive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.
Employee Assistance Program (EAP) to support mental health and well-being.
Generous vacation and sick leave policies, with the ability to roll over unused time.
10 paid company holidays.
Tuition reimbursement for eligible educational expenses.
Remote or hybrid work options available for various positions.