Healthcare Compliance Specialist

2 weeks ago


Sacramento, California, United States Hill Physicians Medical Group Full time
Job Overview

The Clinical Operations Manager will be responsible for managing Quality Management (QM) and Health Resource Management (HRM) department functions, which focus on Hill Physicians Medical Group compliance with delegated activities including NCQA, state, and federal regulatory requirements, and health plan delegation oversight programs for all regions.

You will oversee the preparation for all health plan audits, represent our organization at these audits, and act as the liaison for all UM and QM regulatory and compliance issues. You will also establish QM and HRM standards compatible with health plans, NCQA, state, and federal regulatory requirements, and health plan delegation changes.

In addition to these responsibilities, you will work closely with our HRM analysts to ensure updated letters are generated by the Authorization system, troubleshoot and recommend improvements to system issues related to Tapestry, FaxCom, and other authorization-related systems, and participate in the testing of system changes, upgrades, service packs, etc. as needed.

We estimate the annual salary for this position to be in the range of $85,000 - $118,000, based on industry standards and location.



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