Share this Job

Manager, Regulatory Affairs - Medi-Cal

Date: Apr 23, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 5001 

 

Position Summary/Position

 

Under the direction of the Director of Compliance, the Regulatory Affairs Manager (Medi-Cal) is responsible to manage and oversee the execution of the Medi-Cal contract and licenses. the Regulatory Affairs Manager (Medi-Cal) has an active and visible leadership role with the Department of Managed Health Care (DMHC) and the Department of Health Care Services (DHCS). 
Under the direction of the Director, Compliance . the Manager, Regulatory Affairs (Medi-Cal) serves as a lead liaison for IEHP with regulatory agencies, and positions IEHP as a key influencer, maintaining relationships with DMHC and DHCS. This position works collaboratively with other departments within the Plan acting as a resource to provide analysis and interpretation of regulatory policy guidance, and work with Business Units to ensure compliance with the regulatory requirements of the guidance issued. Additionally, the Manager, Regulatory Affairs (Medi-Cal) plays a key role in crafting and shaping federal and state regulatory policy issues for the benefit of IEHP.
Works very closely with the Manager, Regulatory Affairs (Medicare), as well as other Managers within the Department to ensure alignment of priorities and division of responsibilities.

Major Functions (Duties and Responsibilities)

 

1. Direct the day-to-day operations of the Regulatory Affairs (Medi-Cal) Unit in the most effective manner to meet Plan, department, and unit objectives while ensuring quality and accuracy of the work. Implement standardized processes to maximize efficiency.
2. Oversee employment of Team Members (TMs) including recruitment, performance reviews, training, coaching, and development. 
3. Direct, train, and educate Regulatory Affairs (Medi-Cal) Unit TMs to ensure the Medi-Cal line of business is in compliance with regulatory and contractual requirements. 
4. Develop and implement a regulatory reporting calendar. Define metrics to measure the success of regulatory reporting calendar. If the metrics identify an area of concern, escalate the issue, and take corrective action, as needed.
5. Identify, direct and maintain Regulatory Affairs (Medi-Cal) Unit metrics for the purpose of driving process improvements and efficiencies. 
6. Assume a leadership role within the organization and oversee the interpretation of complex federal and state regulatory guidance. Guide the Regulatory Affairs Unit Team Members to serve as a resource to ensure that Business Units are provided with regulatory support to ensure compliance. This includes overseeing the interpretation, distribution, and implementation of All Plan Letters (APLs), Policy Letters (PLs), etc.
7. Lead, guide, manage, and as appropriate attend in the participation of relevant committees and work groups, make presentations, prepare reports, data, or other materials. These may include, but are not limited to: internal workgroups, workgroups convened by trade associations and workgroups convened by regulatory agencies.
8. Lead and oversee Regulatory Affairs Unit Team Member participation of various regulatory agency calls, including the DHCS Weekly Managed Care Plan Calls, and provide feedback to the regulatory agency as well as communicate outcomes, as appropriate, to relevant Business Units.
9. Identify potential risks, non-compliance and/or alleged violations within the Plan, and work with Compliance Audit & Oversight Unit to develop and implement department and unit corrective action plans (CAPs) for resolution. Partner with Business Units and provide guidance on how to avoid or prevent similar risks in the future. 
10. Work closely with the Director of Compliance to support the CEO in fostering strong relationships with regulatory agencies. Oversee and manage the development of memos for the CEO and senior leadership to provide analysis on key emerging regulatory policy issues.
11. Serves as the primary state liaison by establishing collaborative working relationships with DMHC and DHCS. Partners with Government Affairs, participating in selective collaborative relationships with the California Association of Health Plans (CAHP), Local Health Plans of California (LHPC), other trade associations, as well as Medi-Cal Managed Care Plans that are specific to Regulatory Affairs as needed.  
12. Provides subject matter expertise and collaborates with Government Affairs when requested for responses to trade association inquiries specific to Medi-Cal line of business. Oversee and facilitate resolution of high-visibility, escalated requests, and issues from DMHC and DHCS, including but not limited to Member cases, Provider cases, and Enforcement Matters. 
13. Determine the appropriate objectives, scope, and methodology to ensure Plan compliance with the Medi-Cal contract, contract amendments, Federal and State statutes and regulations, DMHC Letters, DHCS Letters, policy transmittals, bulletins and alerts.

Supervisory Responsibilities

Leader: Administers Hires, Terminations, and Performance Reviews

Experience Qualifications

 

Five to seven (5-7) years with managed care health plan or other relevant industry experience specific to DHCS and/or DMHC requirements. Direct experience interacting with regulatory agencies. Three (3) years supervisory experience.

Preferred Experience

 

Experience in health care,  Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect {CMC). 

Education Qualifications

 

Bachelor’s Degree from an accredited institution required.

Preferred Education

 

Master’s Degree from an accredited institution preferred.

Professional Certification

 

Certified in Healthcare Compliance (CHC) or commitment to obtain within one year of employment. 

Professional Licenses

Drivers License Required

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

Knowledge Requirement

 

Knowledge of principles and practices of managed care operations. Knowledge of Federal and State regulatory requirements related to Medi-Cal (Medicaid), Title 19 (USC)/Title 29 (USC and CFR), Title 22 (CCR), Title 28 (CCR), Title 42 (USC and CFR), CA WIC, and CA Health and Safety Code. Principles of project management.

Skills Requirement

 

Strong leadership and interpersonal skills. Excellent verbal and written communication skills. High level of analytical ability. Strong organizational skills. Microsoft Office programs including, but not limited to: Word; Excel; Power Point; Outlook.

Abilities Requirement

 

Ability to understand, incorporate and demonstrate the mission, vision, and values of the Plan in behaviors, practices, and decisions. Ability to maintain a high level of diplomacy. Ability to analyze complex regulatory requirements. Ability to be resourceful and independent in problem solving and self-direction. Ability to establish and maintain effective working relationships with internal departments and external agencies. Ability to embrace and champion change to accommodate evolving organizational and regulatory processes. Ability to work independently and collaboratively within a team environment. Ability to manage multiple projects with competing deadlines and changing priorities. Strong attention to detail.

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

 

Major Functions (Duties and Responsibilites) Continued:

 

14. Develop, review, and implement internal and external policies and procedures to ensure compliance with the Medi-Cal contract, contract amendments, state and federal statutes and regulations, DMHC Letters, DHCS Letters, policy transmittals, bulletins, and alerts.  Review departmental policies and procedures annually and recommend changes as needed.
15. Lead Medi-Cal compliance initiatives and ensures continuous support for the operational areas during planning, development, and implementation of those initiatives. Assure implementation has been completed.

16. Communicate to all levels of the Plan to ensure support, awareness, and effectiveness of compliance with the Medi-Cal contract, contract amendments, Federal and State statutes and regulations, DMHC Letters, DHCS Letters, policy transmittals, bulletins and alerts. 
17. Cultivate an effective system for ensuring that relevant legislative, regulatory, enforcement and administrative developments and trends are reviewed promptly, analyzed carefully, and communicated to the relevant business leads in a constructive manner.
18. Organize and lead external audits from regulatory agencies. Assure TMs are prepared for the audit and any requested documents are delivered promptly. Act as the contact person during the audit. 
19. Partner with operational areas to ensure operational policies and procedures related to the Medi-Cal line of business are compliant with regulatory and contractual requirements. 
20. Acts in a compliant manner. Supports the IEHP Compliance Program through own actions as well as aligning the expectations of direct reports and unit team members job expectations with compliant practices. Allows time for employees to complete compliance training, supports enforcement of policies and procedures, and proactively engages with team to encourage reporting of incidents of noncompliance.  Follows appropriate guidelines related to disciplinary action up to and including termination for violation of compliance expectations.

 

Working Conditions:

Occasional travel within the continental United States. 

 

 

Physical Requirements

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

 

Starting Salary: $111,550.40  - $142,230.40  

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