Senior Director II, Regulatory Operations

Job Summary

The Senior Director II, Regulatory Operations serves as a senior leader within the Compliance Department, overseeing and driving regulatory compliance and operational excellence within L.A. Care. This senior leadership role requires a strategic and visionary approach to navigating complex regulatory landscapes, driving operational excellence, and fostering a culture of compliance. The Senior Director II leads a large, multi-disciplinary team that includes Regulatory Compliance, Delegation Oversight, and Internal Monitoring. This multifaceted role centralizes several compliance functions critical to L.A. Care's success.   Leadership and management of the Regulatory Operations division involves the strategic oversight & maturity of the regulatory compliance department dedicated to navigating regulatory changes, proactively remaining audit-ready, and staying abreast of industry best practices specific to L.A. Care's ecosystem. Simultaneously, the role extends to leadership in core oversight functions that include enterprise-wide monitoring and oversight of L.A. Care's delegated network. Enhancing the prevention, detection, and correction of compliance issues across the organization is a critical component of the role that requires collaboration with senior & executive leadership

This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Duties

Conduct strategic planning, optimizing resource utilization to meet current and future departmental goals, and ensuring the alignment of departments across the compliance vertical. Develops and directs strategic plans for the entire Regulatory Operations division. Lead and oversee committees that include the Internal Compliance Committee (ICC), the Delegation Oversight Committee (DOC), the Sanctions Committee, and any other committee directed by the executive leadership. Responsible for integrating regulatory oversight, enterprise monitoring, and delegation oversight to ensure L.A. Care's adherence to industry standards and regulations.

Prioritize and support the direct reports in managing day-to-day operations of several compliance units, covering Regulatory Audits & Monitoring, Regulatory Analysis and Communication, Material Review, Regulatory Affairs, Enterprise & Network Monitoring, Delegation Oversight Audit, and Enterprise and Network Clinical Monitoring.   Create and enhance a culture of excellence within the Regulatory Operations division.  Develops goals, objectives and actions plans for assigned staff that includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

Leads a cross-functional effort to mature and enhance the delegation oversight program. Establish a governance framework to guide the organization to ensure delegated entities comply with the requirements. 

Develops a dynamic monitoring program that includes internal and delegate-specific measures. Identify noncompliance issues, possible risks, and enable the compliance department to work with applicable stakeholders to remedy these activities.

Develop and manage budgets effectively to achieve the compliance department goals. Oversee the efficient utilization of both internal and consultative staff to eliminate waste and increase efficiency.

Duties Continued

Drive change management initiatives to ensure the department is successful in adopting cutting-edge digital tools and best practices.

Collaborate with executive leadership in organizing and leading critical compliance committees that includes developing appropriate agendas, reports, and information requested by the committee and/or Board.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 9 years of progressive health care compliance and/or audit experience including extensive experience in compliance or auditing in health care or another highly regulated industry.

At least 8 years of leading staff or supervisory/management experience.

Experience designing, implementing compliance programs, policies and practices; and/or managing health plan/ managed care business operations.  Demonstrate progressive improvement in audit results over time.

Strong background and experience in cross-functional/team based approach to problem solving.

Skills

Required:

Excellent interpersonal, verbal, and written communication skills.

Knowledge of Word and Excel.

Ability to drive strategic vision to accelerate and enhance development of quality control programs for business operations.  Demonstrated ability to brainstorm, develop and implement new compliance/audit initiatives.

Demonstrates significant leadership competencies, including employee engagement, strategic thinking, thorough understanding how to use and manage health care data.

Demonstrates the ability to mentor and train staff, including improving the capacity of staff to achieve the highest levels of independent auditor performance and business collaboration.

Understanding of the vital importance of commitment to excellence and demonstrating a high regard for organizational values.

Strong organization and planning skills and be flexible to handle multiple assignments, changing priorities, and meeting.

Must be able to present findings to various levels of management, across all organizations.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Financial Impact: Salary expense, office equipment