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MGR, Compliance Full Time - Main Office - Santa Barbara, CA, 93110 chevron_right

Company: CenCal Health
Location: Santa Barbara
Posted on: September 21, 2023

Job Description:

Job Details
Job Location: Main Office - Santa Barbara, CA
Position Type: Full Time
Salary Range: Undisclosed
Job Category: Compliance

DescriptionSalary Range: $103,898 - $161,043
Job Summary
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 Program.
Duties & Responsibilities
Supervises Compliance staff, with duties including but not limited to:

  • Recruiting, hiring and retaining qualified staff;
  • Developing and delivering new hire and ongoing training;
  • 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 compliance.
    • Cultivate and manage relationships with local, state, and federal government partners, Associations, and downstream representatives.
    • 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 organization.

      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 procedure process.
      • Implement the Plan's policy and procedure process.
      • Train internal staff and leaders about the Plan's policy and procedure process.
      • 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 approved documents.
      • 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 and procedures.

        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 required timeframes;
        • Oversee the development and administration of FWA training for all staff.

          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 direction).
          Works collaboratively with departments to ensure operations are within compliance and participates as a member of internal sub-committees.
          Contributes to compliance program initiatives, risk assessment and risk plan development.
          Reviews existing compliance policies/procedures and drafts new policies/procedures.
          Contributes to the management of the department budget, resources and staff.
          Completes other special projects and duties as assigned.

          • Effective public speaking, written and verbal communication skills.
          • Effective organizational skills with ability to prioritize assignments, maintain effective administrative support systems, and meet deadlines
          • Ability to work under minimal supervision and exercise independent judgment
          • 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 regulations.
          • Ability to develop policies and procedures.
          • Ability to write, create reports, administer programs, and analyze data.
          • Ability to lead and participate in internal and external committees and meetings.
          • Ability to cultivate a culture of compliance norms and values.

            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 qualifying
            • Three five (3 5) years supervisory/management experience.
            • 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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