Senior Compliance Lead, Medicaid Health Plan Compliance

Senior Compliance Lead, Medicaid Health Plan Compliance

The Health Plan Compliance team assures that Kaiser Permanente's health plan operations align with internal policies, controls, federal and state regulations, and contractual requirements. The Senior Compliance Lead provides guidance, advice, and oversight for health plan functions specific to the Medicaid and D-SNP product lines. Consultative services include assessing state deliverables and reporting for accuracy and completeness, reviewing internal controls to validate effectiveness, and ongoing monitoring to confirm sustained compliance. This position is responsible for managing compliance initiatives specific to government programs operations, including monitoring and oversight. Supports day-to-day activities and guides work efforts to achieve compliant outcomes.

Job Summary : This senior level individual contributor is primarily responsible for conducting company compliance activities in partnership with internal and external stakeholders. Responsibilities include leading compliance reporting efforts and compliance investigations. Additional key responsibilities include driving the implementation of compliance efforts and regulatory compliance through monitoring and interpreting complex regulatory changes. This individual contributor also manages projects or compliance components of larger cross-functional projects including identifying and managing stakeholders.

Essential Responsibilities :

• Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and adapting to and learning from change, difficulties, and feedback.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.
• Conducts company compliance activities by partnering with internal and external stakeholders; applying established regulations and standards to compliance efforts; designing, developing, and executing strategic compliance initiatives; analyzing regulations and regulatory changes, and their application to operations; and documenting compliance activities.
• Leads compliance reporting efforts by evaluating and summarizing compliance data, audit information, and potential risks and remedies; identifying and reporting key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations) to management; and developing presentations to convey key findings to management and other key stakeholders.
• Leads compliance investigations by coordinating the collection and analysis of quantitative and qualitative data; leading interviews as appropriate; researching key business issues; identifying potential action steps; and evaluating and recommending corrective action plans for substantiated allegations.
• Manages projects or compliance components of larger cross-functional projects by identifying and managing stakeholder contacts; assembling teams based on project needs and team member strengths; developing, analyzing, and managing project plans; negotiating and managing project schedules and resource forecasts; and managing project financials and deliverables.
• Drives regulatory compliance by monitoring and interpreting complex regulatory changes; leading analysis on regulatory impacts; and overseeing the implementation of designated changes.
• Drives the implementation of compliance efforts by identifying compliance requirements; leading the assessment of current state compliance to identify gaps and corrective actions; creating or revising complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

Minimum Qualifications :

Additional Requirements :

Location : Oakland, California