Compliance Advisor

Job Category:  Administrative, HR, Business Professionals
Department:  Compliance
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  3287

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

The Compliance Advisor of Delegation Oversight ensures that L.A. Care business units are compliant with all Product Lines' contractual, state and federal regulatory, and accreditation requirements. The  Advisor shall have a working knowledge of DHCS, CMS, and NCQA requirements, as well as highly developed analytical and critical thinking skills, to serve as a resource to internal business units and external entities. The Advisor may investigate, assist with coordination and management of teams and workgroups, project documentation and workflows,  draft and complete presentations, auditing and monitoring of performance standards, and other duties as assigned. The Advisor should have excellent written and verbal communications skilll.

Duties


● Analyze and interpret contractual, state and federal regulatory, and accreditation requirements.

● Participate in and conduct compliance functions, including, but not limited to, developing compliance tools and validating implementation of new requirements and corrective action plans.

● Work with internal business units to prepare reports for distribution to internal Committees and external entities.

● Work with internal business units and/or external entities to correct performance deficiencies.

● Prepare and conduct trainings for internal business units and/or external entities.

● Facilitate and participate in compliance related projects.

● Review, approve and suggest revisions on policies and procedures, member/marketing materials, provider materials, compliance work plans, etc., as well as submit to regulatory entities for approval.

● Conduct and manage audits of L.A. Care subcontracted providers including, but not limited to, Participating Physician Groups, Plan Partners, Specialty Health Plans/Vendors.

● Perform other duties as assigned.

Education

High School Diploma/GED

Associate's Degree or Bachelor's Degree

Experience


Required:
● With Bachelor's Degree: 3-5 years of healthcare related experience.

Ÿ● Demonstrate experience developing and delivering training programs, and making presentations to internal staff and providers.

Preferred: 
● With Master's Degree: 2 years of healthcare related experience.


Required:
● Ability to manage multiple priorities, projects and meet deadlines.

● Excellent verbal and written communication skills.

● Ability to draft policies and procedures.Ÿ

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)


Nearest Major Market: Los Angeles

Job Segment: Medical, Healthcare