MGR, Compliance Full Time - Main Office - Santa Barbara, CA, 93110 chevron_right
Company: CenCal Health
Location: Santa Barbara
Posted on: September 21, 2023
Job Location: Main Office - Santa Barbara, CA
Position Type: Full Time
Salary Range: Undisclosed
Job Category: Compliance
DescriptionSalary Range: $103,898 - $161,043
Under the general supervision of the Compliance Director and
Privacy Officer, the Compliance Manager is responsible for driving
the corporate compliance framework, fostering comprehensive
Compliance Program initiatives that support the organization's
compliance with applicable regulatory, legislative, and contractual
requirements. The Compliance Manager will oversee and ensure that
the day-to-day regulatory reporting functions are carried out and
by coordinating implementation of new and revised healthcare rules
and requirements as are communicated by state agencies. The
Compliance Manager will collaborate with senior and operational
leadership to ensure that operating procedures, systems, and
standards are aligned with compliance requirements and controls The
Compliance Manager will participate in the development and
deployment of new functions to expand compliance activities with
the larger mission of maintenance of an effective Compliance
Duties & Responsibilities
Supervises Compliance staff, with duties including but not limited
- Recruiting, hiring and retaining qualified staff;
- Developing and delivering new hire and ongoing
- Overseeing job performance;
- Prioritizing and assigning work related tasks as needed and/or
as assigned by the Compliance Leadership;
- Training new staff as needed; and
- Conducting performance evaluations.
Manages the regulatory requirements process, with duties including
but not limited to:
- Lead the reading, reviewing, and summarizing prospective, new,
and revised rules and healthcare policy from regulatory agencies,
including but not limited to, the Department of Managed Health Care
(DMHC) the Department of Health Care Services (DHCS), and Centers
for Medicare (CMS).
- Lead and oversee the communication of new or changes in
contractual requirements, federal and state statutes and
regulations, and program requirements to executive leadership,
management, department leaders, and impacted stakeholders.
- Oversee effective and timely guidance with interpreting
regulations and health plan guidelines.
- Lead and oversee the workflows and daily processes for tracking
and ensuring timely and accurate submission of deliverables in
accordance with mandated requirements.
- Lead and oversee the preparation and submission of routine
regulatory reports and analysis to regulatory agencies including,
but not limited to, DHCS, DMHC, and CMS.
- Manage research and response to questions regarding regulatory
- Cultivate and manage relationships with local, state, and
federal government partners, Associations, and downstream
- Collaborate with the Director of Government Affairs to stay
abreast of changes in contractual provisions or regulations and
communicate those changes to relevant staff within the
Manages the policy and procedure process and activities, with
duties including but not limited to:
- Lead the creation and revision of the Plan's policy and
- Implement the Plan's policy and procedure process.
- Train internal staff and leaders about the Plan's policy and
- Maintain version control of policies and procedures, including
coordinating the production of documentation.
- Oversee the tracking of policy and procedures review and
updates by supporting policy owners with their review, ensuring
documents are routed to the appropriate committees in time, and
working with relevant staff to ensure timely publication of
- Train and assist various departments in developing best
practices in their operations in accordance with established
policies and procedures.
- Maintain knowledge of business products and related policies
Oversees and manages FWA compliance processes and activities, with
duties including but not limited to:
- Assist with tracking and investigating reports of alleged FWA
or non-compliance or regulatory violations received from external
and internal sources;
- Ensure that investigations are processed through to resolution
and are reported to the appropriate parties/entities within
- Oversee the development and administration of FWA training for
Ensures that Compliance projects support and achieve CenCal
Health's Compliance Program goals.
Provides support in Compliance Department committee-level meetings
(i.e. agendas, minutes, charter adherence and department
Works collaboratively with departments to ensure operations are
within compliance and participates as a member of internal
Contributes to compliance program initiatives, risk assessment and
risk plan development.
Reviews existing compliance policies/procedures and drafts new
Contributes to the management of the department budget, resources
Completes other special projects and duties as assigned.
- Effective public speaking, written and verbal communication
- Effective organizational skills with ability to prioritize
assignments, maintain effective administrative support systems, and
- Ability to work under minimal supervision and exercise
- Diplomacy and tact in handling sensitive information regarding
personnel affairs, as required
- Ability to interact with executives and vendors effectively,
handing all assignments with efficiency
- Ability to lead others and formulate business strategy
- Strong critical thinker
- Ability to research and interpret state and federal
- Ability to develop policies and procedures.
- Ability to write, create reports, administer programs, and
- Ability to lead and participate in internal and external
committees and meetings.
- Ability to cultivate a culture of compliance norms and
Education & Experience
- Bachelor's degree in Business, Health Care Administration or a
related field required
- Minimum of five (5) years of related experience in the
healthcare industry with managed care experience preferred; or an
equivalent combination of education and experience which would
provide the required knowledge, skills and abilities may be
- Three five (3 5) years supervisory/management
- Certified in Healthcare Compliance (CHC) is preferred.
Keywords: CenCal Health, Santa Barbara , MGR, Compliance Full Time - Main Office - Santa Barbara, CA, 93110 chevron_right, Administration, Clerical , Santa Barbara, California
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