Regional Director - Managed Care Compliance

Managed Care Compliance Program Manager

Primary Duties And Responsibilities :

1. Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations.

2. Oversees Policy And Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers.

3. Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff.

4. Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements.

5. Establishes / implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies.

6. Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators.

7. Manage Compliance Department's administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars.

8. Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc.

9. Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance.

10. Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.

Department-Specific Responsibilities :

Compliance : Serves as Chair of the Managed Care Compliance Committee. Prepares agenda and arranges for the regular and ad hoc meetings of the Managed Care Compliance Committee

Supervisory / Management Responsibilities :

Manages Compliance Department staff to include overseeing the work of others, assigning or allocating work to team, and ensuring work is completed according to deadlines and quality standards.

Teamwork / Customer Relations Responsibilities :

Collaborates to make decisions to achieve desired outcomes

Establishes effective working relationships with cross-functional teams, external stakeholders.

Job Qualifications :

Education : Bachelor's degree from an accredited four-year institution required

Master's degree in healthcare administration, Law, Public Administration, or Business Administration strongly preferred.

Work Experience : Minimum 7 years work experience in regulatory affairs and / or compliance

Minimum 5 years work experience in California managed care regulatory affairs and / or compliance

Minimum 5 years work experience in providing guidance to senior level leaders

Licenses and Certifications :

Certification in Healthcare Compliance - Preferred

Salary Range : $125,000 - $185,000 / yr

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