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Compliance Program Manager

2 months ago

French Camp, California, United States SAN JOAQUIN COUNTY HEALTH COMMISSION Full time
Job Title: Compliance Program Manager

Job Summary:

We are seeking a highly skilled Compliance Program Manager to join our team at SAN JOAQUIN COUNTY HEALTH COMMISSION. As a Compliance Program Manager, you will be responsible for maintaining oversight responsibilities of assigned internal and delegated third-party entities and overseeing their performance of non-clinical managed care operations and activities to ensure compliance with state, federal, and NCQA requirements and HPSJ goals and objectives.

Key Responsibilities:

  • Serve as HPSJ's one point of contact and build collaborative working relationships with assigned internal department leads and third-party entities in matters related to their contractual and regulatory obligations.
  • Monitors and tracks service levels/performance for assigned internal and third-party entities.
  • Conducts Readiness Assessments (Pre-Delegation or Pre-Contractual) of applicable non-clinical areas for third-party entities to ensure the ability to perform business activities prior to contract execution and in accordance with state, federal, NCQA, and other regulatory requirements.
  • Conducts internal and external audits of non-clinical operational functions based on regulatory and contractual requirements.
  • Responsible for oversight and monitoring of non-clinical operational areas for internal and external delegates and vendors, including but not limited to, Claims, Customer Service, Provider Relations, Network Adequacy, Transportation, Cultural & Linguistics, and Vendor Oversight.
  • Compiles dashboards and communicates results timely with internal and external stakeholders.
  • Reviews and analyzes reports to identify areas of risk; escalates risk areas to Manager, Director, and other internal stakeholders for further actions.
  • Escalates prolonged or non-responsive performance issues to the following, but not limited to, Executive Team, Compliance Committee, Audit & Oversight Committee, and/or Provider Contracting for further disciplinary action and/or remediation planning.
  • Issues internal and external corrective action plans for non-compliance with plan policies, regulatory, and contractual requirements; works collaboratively to ensure remediation of corrective action plans.
  • Collaborates with Compliance and provides webinar training or written communication to internal and external delegates on applicable regulatory changes.
  • Leads or participates in regular or ad hoc Joint Operations Meetings (JOM) with assigned third-party entities regularly, in addition to focused performance meetings.
  • Conducts relevant training and education, as needed.
  • Provide comprehensive support and serve as a backup for team members across various functions, ensuring seamless continuity of compliance program management and oversight during absences or high-demand periods.

Requirements:

  • In-depth knowledge of the delegation oversight process in a regulated managed care environment.
  • In-depth knowledge of State, Federal, and NCQA requirements and standards related to Medi-Cal and Medicare D-SNP Programs.
  • In-depth knowledge of audit, control, and monitoring processes, and the ability to effectively implement and maintain them.
  • Knowledge of and ability to effectively apply the principles and best practices of project management, including but not limited to project lifecycle, scope definition and management, planning and scheduling, monitoring, communication cycles, project team, and risk management.
  • Builds partnerships and works collaboratively with others to meet shared objectives.
  • Strong interpersonal skills, with the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.
  • Strong oral and written communication skills, with the ability to communicate professionally with diverse individuals and groups inside and outside of HPSJ.
  • Strong presentation skills, including but not limited to the ability to tailor presentations to a specific audience, and identify key messages.
  • Strong problem-solving and analytical skills, with the ability to determine key issues, develop effective action plans, including escalation, and implement to successful conclusion.
  • Strong leadership skills, including but not limited to the ability to influence without authority and motivate others; ability to hold third parties accountable for performance.
  • Produces work that is accurate and complete.
  • Produces the appropriate amount of work.
  • Actively learns through experimentation when tackling new problems, using both successes and failures to learn.
  • Rebounds from setbacks and adversity when facing difficult situations.
  • Knows the most effective and efficient process to get things done, with a focus on continuous improvement.
  • Ability to work independently and as part of a team.
  • Ability to read, understand, and apply complex written guidelines, instructions, and other materials.
  • Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines consistently.
  • Strong knowledge of change management theory and ability to implement and manage effectively.
  • Commitment to and ability to facilitate the adoption of HPSJ's strategy, vision, mission, and values.
  • Proven arithmetic skills.
  • Advanced skills in Word, Excel, PowerPoint, and Visio.
  • Proficient with MS Excel, Power BI, or other dashboarding tools.
  • Intermediate skills in SharePoint.
  • Ability to speak, be understood, read, and write in English.
  • Ability to handle confidential information with appropriate discretion.

Preferred Qualifications:

  • Experience with Medi-Cal and Medicare D-SNP managed care operations.
  • Knowledge of the compliance oversight requirements, regulations, and/or processes.
  • Knowledge of applicable CMS and State regulatory requirements, Medicare, and Medi-Cal program and benefits.

What You Will Get:

HPSJ Perks:

  • Competitive salary
  • Robust and affordable health/dental/vision with choices in providers
  • Generous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee's birthday, and 9 paid holidays)
  • CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan
  • Two flexible spending accounts (FSAs)
  • Employer-Paid Term Life and AD&D Insurance
  • Employer-Paid Disability Insurance
  • Employer-Paid Life Assistance Program
  • Health Advocacy
  • Supplemental medical, legal, identity theft protection
  • Access to exclusive discount mall
  • Education and training reimbursement in addition to employer-paid elective learning courses.
  • A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
  • A shorter commute – if you're commuting from the Central Valley to the Bay Area.
  • Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation, or any other characteristic made unlawful by applicable Federal, State, or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.