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Compliance Manager, Santa Barbara, CA


CenCal Health

Manager

Santa Barbara, CA

September 20, 2018


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Compliance Manager

Manager

Posted: September 18, 2018
Full-Time
Santa Barbara, CA, United States

Job Details

Description

Supervises Compliance staff, with duties including, but not limited to:

  • Developing and delivering new hire and ongoing training
  • Overseeing job performance
  • Assigning work related tasks as needed and/or as assigned by the Compliance Officer; and Conducting performance evaluations
  • Maintains the policies and procedures that assure the Plan’s operations remain in compliance with legal, contractual, and regulatory requirements
  • Participates in the development and deployment of new functions to expand compliance activities with the larger mission of maintenance of an effective Compliance Program

Oversees and manages FWA compliance processes and activities, with duties including, but not limited to:

  • Overseeing the process of tracking and investigating reports of alleged FWA from external and internal source
  • Ensuring that investigations are processed through to resolution and are reported to the appropriate parties/entities within required timeframes
  • Managing internal/external audits, audit findings, responses and corrective action plans
  • Oversees the development and administration of FWA training for all staff

Collaborates with CenCal Health’s operations management to ensure compliance with legal, contractual, and regulatory requirements, with duties including but not limited to:

  • Maintenance of a system for the maintenance of policies and procedures, to ensure compliance with relevant state and federal requirements, contractual requirements, and/or industry standards
  • Coordination of routine audits conducted by the Department of Health Care Services and the Department of Managed Health Care
  • Oversight of the submission of operational Plan data to the Department of Health Care Services and the Department of Managed Health Care (“upstream reporting”)
  • Ensure that the Plan meets ongoing non-routine reporting requirements that are requested by the Department of Managed Health Care and Department of Health Care Services
  • Collaboration 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

Qualifications

Experience

Preferred

  • Bachelor’s degree in Business, Health Care Administration or a related field strongly preferred • 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 providing the required knowledge, skills and abilities • Three (3) years supervisory/management experience

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