Manager UM Compliance and Audit

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. Qualifications Location Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States. What Liberty Offers Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with: • 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. Compensation In the spirit of pay transparency, the base salary range for this position is $175,000 - $205,000 a year, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions. Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth. Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements. Sponsorship and Relocation Specifications Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time. Apply tot his job Apply To this Job