Manager, Policy & Regulatory Operations (Hybrid Work Schedule)

Date: Jan 12, 2023

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 8431 

 

Position Summary/Position

 

Under the direction of the Director of Policy & Regulatory Operations, the Policy & Regulatory Operations Manager is responsible for leading a team of analysts that help ensure Health Services, Quality Systems, Provider Services, and Member Services remain in compliance with Local, State, Federal, contractual and accreditation requirements by supporting these departments in areas of policy administration, regulatory implementation and operational strategies.

The Policy & Regulatory Operations Manager is responsible for the daily activities and functions of their team including the management, evaluation, mentoring, and coaching of direct reports. The Policy & Regulatory Operations Manager is also responsible for the quality assurance review of internal and Provider policies for Health Services, Quality Systems, Provider Services, and Member Services, and may represent these departments in cross functional strategic programs/initiatives.

Major Functions (Duties and Responsibilities)

 

1. Direct the day‐to‐day operations of their team in the most effective manner to meet Plan, department and unit objectives while ensuring high‐productivity and high‐quality work. Implement standardized processes to maximize efficiency.
2. Responsible for the employment of their Team Members, including recruitment, training, management, coaching, evaluation, and development.
3. Lead a team of analysts in providing leadership and management of implementation projects, which may include but not be limited to those that support regulatory compliance, system enhancement, process development and improvement a single or multiple department(s) in within and outside of Health Services, Quality Systems, Provider Services, and Member Services.
4. Manage policy administration activities in Health Services, Quality Systems, Provider Services, and Member Services to ensure internal and Provider policies are kept current, accurate and in accordance with applicable regulatory and accreditation requirements. This responsibility includes but is not limited to supporting the management and publication of the IEHP Provider Manual of Policies and Procedures, Electronic Data Integration (EDI) Manual and internal department manuals.
5. Manage the timely and comprehensive assessment or examination of Health Services, Quality Systems, Provider Services, and Member Services’ policies, systems, and standard procedures against new regulations for the purpose of identifying the health plan’s state of compliance, regulatory and process gaps, and action plan.
6. Manage the timely, quality, and comprehensive completion of audit‐related submissions and inquiries.
7. Provide staff with clear directions and expectations and provide an environment that fosters high productivity and high‐quality work. Ensure that the team has clear goals and objectives that are measurable and achievable.
8. Work closely with other departments and units within IEHP and participate in cross‐functional committees and/or workgroups to accomplish any primary or secondary goals of Health Services, Quality Systems, Provider Services, and Member Services.
9. Support LEAN initiatives by including Standard Work in all activities. Utilize the knowledge obtained from trainings received during LEAN events and incorporate techniques learned into daily activities, as well as activities to analyze and design appropriate resolutions. Actively participate in huddles asking appropriate questions to ensure the Policy and Regulatory Operations department’s day-to-day operations are running efficiently.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

A minimum of five (5) years of experience in managed care, with direct experience in a project management capacity, including all aspects of process development and execution of strategic programs. A minimum of three (3) years supervisory experience is required.

Education Qualifications

 

Bachelor’s degree in Public Health, Health Administration, Public Administration or another similar field from an accredited institution is required.

Preferred Education

 

Master’s degree from an accredited institution is preferred.

Drivers License Required

Yes, must have a valid California Driver's License.

Knowledge Requirement

 

Demonstrated knowledge of principles and practices of managed care operations, compliance and project management.

Skills Requirement

 

Demonstrated skills in sound decision‐making, strategic planning, regulatory review and implementation, policy development, and project management. Must have excellent writing, interpersonal communication, and organizational skills. Must have the ability to lead teams to achieve results while fostering a climate of engagement and employee satisfaction.

Abilities Requirement

 

Ability to persuade, encourage and motivate. Ability to elicit cooperation from a wide variety of sources, including management and staff. Ability to bring projects to successful completion. Ability to effectively prioritize and execute tasks in a high-pressure environment is crucial. 

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

 

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Work Model Location

Hybrid

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

A reasonable salary expectation is between $103,708.80 and $132,225.60, based upon experience and internal equity.

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, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and 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 stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.


Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles