Advisor Compliance Policy and Regulatory

Job Summary

The Advisor Compliance Policy and Regulatory is responsible for managing, developing, and implementing health compliance strategies to ensure compliance with Medi-Cal regulations and alignment with the organization’s strategic goals.

This position collaborates with L.A. Care Cabinet members, Compliance team leaders, Compliance and Quality Committee members, governmental agencies, healthcare providers, and community stakeholders to advocate for compliance strategies that improve access, quality, and sustainability of Medi-Cal services, Covered California, and D-SNP.

Additionally, this position works closely with Cabinet members for ensuring Compliance has appropriate stakeholder engagement and alerts the Chief Compliance Officer of any issues and risks not being addressed or mitigated. The advisor supports the execution of the Annual Compliance Work Plan and provide the necessary support to seek completion of key activities in Compliance.

This position collaborates with key stakeholders to review programs, projects, processes, procedures, and policies; and to conduct end-to-end root cause analysis to enhance and improve outcomes and remediate issues to comply with the national and statewide standards and regulations.

Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics.

Duties

Develops reports, analyzes data and provides presentation on status of areas of responsibilities on an as needed basis in support of department operations.

Partners with the management to communicate compliance and operational priorities and provide feedback or follow-ups to key stakeholders.

Acts as the point of contact for key strategic initiatives. 

Provides expert advice to various business units on relevant topics within the organizational standards, national and state-wide compliance.

Conducts research and analysis of business performance and improvements with key stakeholders to document current state, identify gaps and present remediation plan/options to leadership.  Leads the implementation of initiatives and monitor for successful outcomes.

Policy Development and Implementation: Lead the development of health policies related to Medi-Cal services, ensuring alignment with state and federal regulations and the mission of the local health plan.

Regulatory Compliance: Ensure the health plan adheres to Medi-Cal and related healthcare regulatory standards, including timely implementation of legislative and policy changes.

Advocacy and Representation: Serve as the primary representative for the health plan in discussions with state and federal agencies, including the Department of Health Care Services (DHCS), legislators, and other stakeholders.

Government Relations: Develop and maintain relationships with key policy-makers and advocacy groups to influence health policy in support of the organization’s goals.

Strategic Planning: Work closely with the executive leadership team to integrate policy considerations into the organization’s strategic plans, ensuring policies promote improved patient outcomes and operational efficiencies.

Duties Continued

Stakeholder Engagement: Lead efforts to engage and collaborate with healthcare providers, advocacy groups, and community organizations to support the implementation of Medi-Cal policies.

Policy Research and Analysis: Oversee research and analysis of emerging health policy trends, legislation, and regulatory changes that could impact the local Medi-Cal plan and its beneficiaries.

Communication and Education: Ensure clear and consistent communication regarding policy changes and compliance requirements across all levels of the organization, as well as with external partners.

Leadership and Team Management: Lead a team of policy experts, ensuring effective policy analysis, strategy development, and advocacy efforts are implemented to advance the goals of the health plan.

Collaboration and Cross-Functional Support: Work closely with Cabinet, Compliance, IT, and other departments to integrate compliance risk management. Provide expert guidance to internal stakeholders on compliance and regulatory policies.

Reporting and Communication: Develop and deliver regular quarterly reports on stakeholder engagement.

Communicate cross-departmental compliance risk issues and mitigation plans effectively to both internal and external audiences. Provide updates on Compliance Workplan completeness.         

Perform other duties as assigned.                                                                                                              

Education Required

Education Preferred

Experience

At least 5 years of experience in healthcare policy, government relations, or regulatory affairs, preferably in a Medi-Cal or Medicaid environment.

Experience working with state and federal healthcare regulatory agencies.

Experience and Proven track record of successfully advocating for health policy initiatives.

Preferred:

Experience with California’s Medi-Cal programs and public health systems.

Skills

Required:

Strong understanding of Medi-Cal regulations, healthcare policy, and public health issues in California.

Excellent strategic thinking, leadership, and decision-making skills.

Strong communication and relationship-building abilities, with experience working with diverse stakeholders.

Ability to navigate complex regulatory environments and advocate effectively for policy change.

Excellent organization skills.

Proficiency with Microsoft Office applications (Word, Excel, Access, PowerPoint).

Ability to collaborate with cross-functional teams and influence decision-making.

Preferred:

Established relationships with policymakers,5 regulators, and advocacy groups in the healthcare field.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information