Manager, Compliance (Non-Clinical Audit & Oversight)

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

We are hiring a Compliance Non-Clinical Audit & Oversight Manager to join our team!

Must reside in California - Remote position.

What You Will Be Doing:

Under general supervision responsible for developing and implementing business plans and overseeing internal and delegate non-clinical operations and activities to ensure compliance with state, federal and NCQA requirements and HPSJ goals and objectives. Work is varied, moderately complex, and requires a moderate degree of discretion and independent judgment.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions:

• Plans and assigns work; monitors department workload to ensure regulatory requirements are met; makes timely and effective adjustments.
• In coordination with non-clinical business units, serves as the compliance subject matter expert in implementation of regulatory and contractual requirements.
• Works collaboratively with internal customers to design and implement strategies to increase delegates’ compliance with non-clinical regulatory and contractual requirements.
• Works collaboratively with operational leadership to provide input in the development, approval, and review of the delegation agreement and associated responsibilities.
• Oversees the gathering and analysis of data from various sources to improve the procedures for department processes and audits, e.g., surveys, meetings, trends, and other sources of feedback.
• Researches and evaluates related trends in the industry related to delegation oversight and program integrity.
• Provides support to internal non-clinical departments to meet regulatory requirements, accreditation standards or other operational requirements.
• Oversees the review and maintenance of documentation, including desktop procedures, process flows, auditing and monitoring tools and training for staff and external audit SMEs.
• Leads and conducts internal audits of non-clinical operational functions related to regulatory and contractual requirements, including creating and updating audit tools and preparing results.
• Supports audits with State and Federal agencies, including reviewing audit submission, and preparing report requests.
• 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. Prepares materials and participates in the Audit and Oversight Committee to ensure compliance with regulatory and contractual requirements.
• Compiles, develops, and submits or oversees the compilation, development, and submission of internal and external non-clinical reports.
• Develops, implements maintains, and oversees the development, implementation and maintenance of audit and monitoring records, documents, policies, and procedures.
• Promotes and maintains an environment that supports HPSJ’s strategy, vision, mission, and values.
• Hires, supervises, and retains competent staff.
• Accomplishes department objectives by working collaboratively with the Clinical Manager to ensure planning and execution of department goals, as well as audit and monitoring activities.

What You Bring:

Knowledge, Skills, Abilities and Competencies

Required

• In-depth knowledge of the non-clinical delegation oversight process in a regulated managed care environment, including, but not limited to, Claims Operations and Processing, Network Adequacy, Cultural Linguistic, and Customer Service.
• In-depth knowledge of State, Federal, and NCQA requirements and standards related to Medi-Cal and/or Medicare (D-SNP).
• In-depth knowledge of audit and monitoring processes, and implementation of controls, performance dashboard trending, root cause analysis, and effective management of corrective action plans.
• In-depth knowledge of and ability to identify, implement, monitor and analyze relevant non-clinical metrics models, and implement effective interventions based on results.
• Financial acumen: Interprets and applies understanding of key financial indicators to make better business decisions.
• Manages complexity: Makes sense of complex, high volume data sets (e.g., audit universe review), and ambiguity to effectively solve problems.
• Decision quality: Makes sound and timely decisions that keep the organization moving forward.
• Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies.
• Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
• Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organizational goals.
• Ensures accountability: Holds self and others accountable to meet commitments.
• Drives results: Consistently achieves results, even under tough circumstances.
• Persuades: Uses compelling arguments to gain the support and commitment of others.
• Collaborates: Builds partnerships and works collaboratively with others to meet shared objectives.
• Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
• Being resilient: Rebounds from setbacks and adversity when facing difficult situations.
• Strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions, and identify implications.
• Strong oral and written communication skills, including the ability to communicate professionally to diverse individuals and groups inside and outside of HPSJ.
• Strong interpersonal skills, with the ability to establish and maintain effective working relationships with individuals at all levels inside and outside of HPSJ.
• Strong presentation skills, including but not limited to the ability to tailor presentations to specific audiences, and identify key messages.
• Strong knowledge of change management theory, with the ability to implement effectively.
• Strong project management skills and demonstrated ability to lead complex initiatives including but not limited to performing cost-benefit and comparative analysis.
• Strong process management skills, including enacting systems, processes, standards, and operating procedures.
• Strong customer service skills.
• Demonstrated ability to articulate and support HPSJ’s vision, mission, values, and strategy, integrate into management practices, and foster their manifestation among staff.
• Strong supervisory and leadership skills, with the ability to supervise staff in a manner that maximizes employee performance and business results.
• Strong report writing skills with proficiency in using Microsoft Excel and other report writer(s).
• Ability to handle confidential information with appropriate discretion.
• Hires, supervises, and retains competent staff.

What You Have:

Education and Experience

Required

• Bachelor’s degree in Health Plan Administration, Business Administration or related field: and
• At least five years of experience in healthcare administration or other highly regulated industry; and
• At least three years supervisory experience; or
• Equivalent combination of education and experience.

Preferred

• Master’s degree (MBA, MHA) or related field preferred.
• Experience in managing operational and/or vendor compliance and oversight of health-care related activities.

Licenses, Certifications

Required

What You Will Get:

HPSJ Perks:

• Competitive salary
• Robust and affordable health/dental/vision with choices in providers
• Generous paid time off (starting at 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.