Director, State & Federal Programs Compliance

Date: Nov 15, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5313 

 

Position Summary/Position

 

At the direction of the VP/Chief Compliance Officer, oversees the health plan’s State and Federal Compliance/Regulatory Affairs program. Ensures compliance with State and Federal laws, rules, regulations, manuals and transmittals pertaining to the Medi-Cal and Medicare Advantage programs by working with various departments to determine the implementation and operational impact of such laws, rules and regulations on the organization and monitor those laws, rules, regulations, manuals and transmittals with which the organization must comply. May act as the Compliance Officer in the absence of the VP/Chief Compliance Officer.  

Major Functions (Duties and Responsibilities)

 

1. Oversees Medi-Cal and Medicare Regulatory Affairs unit managers and teams by providing leadership, assistance, training, feedback, and motivation necessary to mentor and develop staff.
2. Plans, designs, and implements a comprehensive and dynamic Medi-Cal and Medicare Compliance Program.
3. Collaborates with internal and external department staff and business partners to ensure that processes are in place to identify new laws, regulations, sub-regulatory guidance, and contractual requirements applicable to Medi-Cal and Medicare; distribute new requirements to areas impacted; assist in defining appropriate action; and monitor implementation.
4. Develops, tracks, and monitors compliance performance metrics and prepares performance and compliance reports to leadership.
5. Responds to compliance findings or issues from State and Federal regulators and government agencies, ensuring corrective actions are implemented.
6. Works with other departments to ensure accurate data is submitted timely to State and Federal regulators in compliance with contractual reporting requirements.
7. Performs with broad discretion and independence the preparation and review of all regulatory filings related to the health plan's Knox-Keene and Medicare licenses (ex. contracts, benefits, delivery systems, new products), and partners with key operations leaders to ensure alignment of health plan operations, care delivery, policies, State and Federal regulatory requirements, and Medi-Cal and Medicare administrative health plan functions, including but not limited to DHCS DMHC All Plan Letter implementation, CMS HPMS memos, audits, and contract administration.
8. Serves as a key point of contact for State and Federal regulatory agencies interfacing with the health plan regarding compliance issues, regulatory inquiries and  audits and corrective actions.
9. Develops, coordinates and conducts Medi-Cal and Medicare-specific training programs for the organization’s employees and first tier, downstream and related vendors.
10. Reviews, communicates and monitors all new legislation, regulations and changes in State and Federal laws to ensure the implementation of regulatory requirements at the operational level and to maintain organizational compliance. 
11. Conducts independent investigations on issues of non-compliance and report out findings and mitigation strategy to the CEO, Executive Team and/or IEHP Governing Board as deemed appropriate by the VP/Chief Compliance Officer.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

A minimum of ten (10) years of experience in Healthcare, with at least five (5) years in a progressive leadership role in Compliance and/or Regulatory Affairs within a managed care setting. Must have demonstrated knowledge of Medicare and/or Medicaid regulations and experience with applying those regulations into a compliance framework.

Preferred Experience

Education Qualifications

 

Bachelor’s degree in a related field from an accredited institution required.

Preferred Education

 

Master’s degree from an accredited institution preferred.
Juris Doctorate from an accredited institution preferred.
Clinical Degree from an accredited institution preferred.

Professional Certification

 

Certified in Healthcare Compliance (CHC) preferred. 

Professional Licenses

Drivers License Required

Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.

Knowledge Requirement

Skills Requirement

 

Strong analytical skills with emphasis on time management, financial analysis, project management and problem solving. Exhibits exemplary oral and written communication skills. This includes the ability to share information in an organized, clear and timely manner, both verbally and in writing, keeping peers, colleagues, staff, board members and committee members appropriately informed. Keeps multiple audiences informed, including the ability to exercise discretion in communications with varied stakeholders, to ensure that information is provided appropriately and confidentially, as warranted.

Abilities Requirement

Commitment to Team Culture

 

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

 

Word processing involving computer keyboard and screens, automobile travel within the Inland Empire. 

Physical Requirements

Keyboarding: Traditional - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Sitting - CONSTANTLY
Lighting - CONSTANTLY
Indoors - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

 

Starting Salary: $144,976.00  - $184,849.60  

Pay rate will commensurate with experience

 

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

 


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles