Compliance Manager, Santa Barbara, CA
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.
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 sources;
- Ensuring that investigations are processed through to resolution and are reported to the appropriate parties/entities within required timeframes;
- Managing internal/external audits, and 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.
Under the direction of the Compliance Officer, maintains and monitors the organization’s compliance plan, with duties including but not limited to:
- Ensuring that Compliance projects support and achieve CenCal Health’s Compliance Program goals;
- Working with the Compliance Committee to ensure staff are educated and trained on the compliance program; and
- Researching and responding to staff questions regarding regulatory compliance;
- Development and oversight of an internal audit function;
- Preparation of agenda for the Compliance Committee and any related subcommittees, transcription of committee minutes and maintenance of all associated records;
- Maintains and solicits routine approval of the Plan’s Code of Ethics document.
- Other duties as assigned
Bachelors or better in Health Administration or related field.
3-5 years: Supervisory/management experience
5 years: Experience in the healthcare industry with managed care preferred
• Excellent oral and written communication skills • Excellent organizational skills with ability to prioritize assignments, maintain effective administrative support systems, and meet deadlines • Ability to 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