Regulatory Analysis and Communications Compliance Advisor II

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

Los Angeles, CA, US, 90017

Position Type:  Full Time
Requisition ID:  5034

 

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 Regulatory Analysis and Communications Compliance Advisor II ensures that L.A. Care business units are compliant with all Product Lines' contractual, state and federal regulatory, and accreditation requirements. This position shall have a working knowledge of Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services(CMS), and National Committee for Quality Assurance (NCQA) requirements, as well as highly developed analytical and critical thinking skills, to serve as a resource to internal business units and external entities. This position 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.

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.

 

Disseminate regulatory guidance to internal and external stakeholders and Plan Partners, and assist with the organization-wide interpretation and implementation of the disseminated regulatory guidance.

 

Assist with managing the organization’s policies and procedures process, compliance trainings, regulatory contract metrics monitoring and reporting systems, and vendor contracts.

 

Perform other duties as assigned.
 

Education Required
Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Master's Degree
Experience

Required:
At least 3-5 years of healthcare related experience with the demonstrated experience on the following list of stated knowledge/experience/skills.

 

Demonstrated experience developing and delivering training programs, and making presentations to internal staff and providers.

Skills

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

 

Excellent verbal and written communication skills.

 

Ability to draft policies and procedures.

Licenses/Certifications Required
Licenses/Certifications Preferred
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)


Nearest Major Market: Los Angeles

Job Segment: Medical, Medicare, Medicaid, Healthcare