Manager, Regulatory Audits

Job Summary

The Manager, Regulatory Audits serves as a leader within the Compliance Department. The Manager manages the Regulatory Audits unit and includes the various required regulatory audits by the State, Federal, and Local agencies. The Manager oversees the enterprise-wide audit readiness program to ensure ongoing compliance and regulatory audit readiness. The Manager develops regulatory reports, agendas, minutes and communications to the Internal Compliance Committee (ICC) and the Compliance and Quality Committee of the Board of Governors. The Manager prepares executive summaries and audit reports, develops and conducts training activities for upcoming audits to peers and L.A. Care business units. 

The Manager advises and supports the senior management on other duties as assigned to support the mission and responsibilities of the Compliance Department,  and to support the mission and business operations of L.A. Care Health Plan.

The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Manage staff, including, but not limited to: hiring staff, monitoring of day-to-day activities of staff, monitoring of staff performance, performance reviews, mentoring, training, and cross training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, disciplinary matters for direct reports, among others.

Develop goals, objectives and actions plans for assigned staff. 

Develop and timely revise policies and procedures, desktop manuals and other guidance for effective and efficient administration of team functions. Lead special projects as needed.

Design and implement comprehensive audit plans in alignment with regulatory requirements and organizational objectives.

Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.

Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.

Oversee the execution of regulatory audits, including planning, scheduling, conducting fieldwork, and reporting findings.

Prepare clear and concise audit reports documenting findings, recommendations, and corrective actions, and present them to senior management and regulatory authorities as required.

Implement quality assurance measures to ensure the effectiveness and reliability of audit processes and findings. Maintain accurate and organized audit documentation and records in accordance with regulatory and organizational requirements. Collaborate effectively with cross-functional teams, including legal, compliance,

Duties Continued

finance, IT, and operations, to address audit findings, implement corrective actions, and drive organizational change.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 5 years of progressive experience in internal or external auditing, regulatory compliance, or related fields.

At least 3 years of leading staff or supervisory/management experience.  Demonstrated experience leading and managing audits, preferably in a regulated industry such as banking, finance, healthcare, pharmaceuticals, or manufacturing.

Experience with implementing or supporting the implementation of managed Medicare, Medicaid or commercial regulations.

Equivalency: 

Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Skills

Required:

Strong organizational and planning skills, including flexibility to handle multiple assignments, changing priorities, and compressed deadlines. 

Proficient in MS Office, including with Word and Excel.

Excellent interpersonal, verbal and written communication skills.

Strong analytical and problem-solving skills, with the ability to analyze data, evaluate controls, and identify trends, patterns, and anomalies.

Proficiency in using data analytics tools and techniques to enhance audit effectiveness and efficiency.

Proficiency in project management methodologies, tools, and techniques, with experience in planning, executing, and monitoring audit projects within established timelines and budgets.

Preferred:

Deep understanding of the healthcare industry, regulatory model, products, services, and regulatory agencies. Familiarity with industry-specific regulations, challenges, and emerging trends is beneficial.

In-depth understanding of relevant regulatory requirements, standards, and frameworks applicable to the managed health care industry. Familiarity with regulatory bodies such as the Centers for Medicare and Medicaid Services (CMS), the Department of Managed Healthcare (DMHC), and the Department of Health Care Services (DHCS).

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information