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Manager, Compliance and Network Oversight

Job Category:  Management/Executive
Department:  Enterprise Performance Optimization
Location: 

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  7032

 

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.

 

“As a condition of employment, L.A. Care requires a COVID-19 vaccine. This requirement includes our remote workforce. If you would like to request an exemption, L.A. Care has implemented a process to consider exemptions, for documented medical conditions and sincerely held religious beliefs. L.A. Care will review all exemption requests prior to proceeding with the recruitment process.”

Job Summary

The Manager of Enterprise and Network Oversight is an integral part of ensuring the success of the Enterprise Performance Optimization Program (Enterprise POP) and the Network Performance Optimization Program (Network POP), to ensure Plan and Network performance excellence. This position  works closely with Leadership and supervises a team of direct reports, and other staff as project assignments may require. This position  is responsible for helping execute and monitor strategic plans and programs designed to achieve the Department's business goals and objectives. Within an assigned scope and projects, the Manager helps lead initiatives that optimize Enterprise and Network performance.

 

The Manager must maintain subject matter expertise of all requirements and performance standards corresponding to assigned functions and projects. This position  manages a team that will aggregate federal, state, contractual, accreditation, and Plan-imposed requirements applicable to the Enterprise and L.A. Care's Plan Partners and Provider Network for all lines of business (Medi-Cal, Personal Assistance Services Council (PASC-SEIU), L.A. Care Covered (LACC) and LACC Direct (LACC/D), and the Cal MediConnect Program (CMC) and Dual-Eligible Special Needs Plan (D-SNP)).  For any given project or issue, this position will identify and actively engage a complete group of stakeholders to assure that related fiscal and operational impacts, and risk and liability-producing factors attendant to the implementation of requirements or policy are properly considered and adjudicated by the right parties. As rule-making evolves, this position  is responsible for keeping abreast of such changes, and partnering with stakeholders to ensure cross-functional impacts are accounted for and that all policy-making and other artifacts demonstrating the implementation of said rules are documented. In collaboration with key stakeholders, this position leads the performance of proactive gap and risk analyses; track, trend, analyze, and report results to enable leadership to make evidence-based decisions to remediate extant deficiencies and engage in process improvement to achieve optimal internal and external performance.

 

Specific to an assigned scope, this position manages a team to establish and oversee the development and maintenance of Key Performance Indicators (KPIs or Metrics) to systematically assess, track, and trend internal L.A. Care performance and external delegate performance.  This position is responsible for ensuring that remediation planning is both satisfactory and implemented for all detected issues, in collaboration with internal units and providers.  This position manages a team as they examine, and as necessary, strengthen process integrity and controls to manage accountabilities, mitigate risks, and protect the Plan from process waste, enforcement actions, sanctions, and other adverse outcomes, in collaboration with key stakeholders. Manages all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct and indirect staff reports.

 

Duties

Manages a team to oversee all phases of Enterprise, Network, and Plan Partner performance related to an assigned scope, including: helping to research and distill requirements into actionable form and set performance standards, performing proactive gap and risk analyses, developing and monitoring metrics to track ongoing fidelity to these requirements, analyzing and reporting results to Leadership, and collaborating to take corrective action to remediate issues of non-compliance. Responsible for maintaining documentation to support evidence of compliance with all requirements, for the reporting of performance data, and for auditing all delegated entities.

 

Reviews policies and procedures (P&Ps), internal controls, and processes to identify gaps and opportunities for improved performance and to ensure that L.A. Care, its Plan Partners, Network, and vendors demonstrate adherence to applicable requirements in timely updated P&Ps, workflow(s), and other artifacts.

 

Oversees team efforts to partner with the functional business leaders, Compliance, Legal, and Quality Improvement to coordinate responses to regulatory inquiries and actions, and to the NCQA, and assists in preparing for and responding to internal and government audits; examines audit findings and collaborates to respond to cited deficiencies; and monitors implementation of corrective action plans.

 

Proactively informs the organization, senior Leadership, and relevant committees, including the Internal Compliance Committee (ICC) of possible risks and issues with sub-optimal internal and external criteria-based performance, and develops remediation and corrective action plans, as appropriate.

 

Manages assigned staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues raised by staff. Encourages staff to provide recommendations for relevant process and systems enhancements, among others.

 

Performs other duties as assigned.

Education Required

Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Juris Doctor Degree or Doctor of Law Degree (J.D.)
Master's Degree in Public Health or Related Field

Experience

Required:
Minimum of  5-7 years of experience in risk management and/or contract and/or regulatory and/or accreditation requirements analysis in managed care or other related health care industry.

 

At least 3-4 years of supervisory/management experience.

 

Minimum of 5 years of experience in Healthcare Compliance, Risk Management, Legal, or related field, in a complex and high-demand business setting.

Skills

Required:
Demonstration of both qualitative and quantitative analytical skills.

 

Proven ability to work with a diverse group of people, including external entities, physicians, support staff, coworkers and management.

 

Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.

 

Demonstrated critical thinking and problem solving skills.

 

Strong written and verbal communication skills.

 

Strong elicitation and process documentation skills.

 

Strong organizational and communication skills to build and foster effective relationships.

Licenses/Certifications Required

Licenses/Certifications Preferred

Certified HealthCare Compliance (CHC)
Certified in Healthcare Compliance Fellow (CHC-F)
Certified Compliance & Ethics Professional (CCEP)

Required Training

Additional Information

 

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)

 

At L.A. Care, we value our team members’ safety. In order to keep our work locations safe, each employee is required to self-screen for symptoms prior to entering any L.A. Care location each day. L.A. Care and all of its staff are required to comply with all state and local masking orders. Therefore, when on-site at any L.A. Care location, employees are expected to wear a mask in areas where physical distancing cannot be managed.

 


Nearest Major Market: Los Angeles

Job Segment: Medical, Risk Management, Public Health, Healthcare, Finance

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