San Diego, California
Manager of Healthcare Commercial Compliance Job Opening in San Diego, California - Required Skills and Qualifications
Undergraduate degree in business, law or health care
Five (5) years experience in position requiring high levels of cooperation, collaboration, and management of staff
Experience in a leadership role, ideally leading and implementing a comprehensive compliance program
Experience conducting research, thorough analysis, and interpretation of findings
Knowledge of state and federal regulations including California Code of Regulations, especially Title 28, and the Knox-Keene Act
Knowledge of health plan operations
Familiarity with implementation of applicable federal laws including but not limited to ERISA, COBRA, HIPAA, IRS, Public Health Services
Experience with and knowledge of National Association of Insurance Commissioners (NAIC) model rules and other standards
Knowledge of accreditation standards related to delegation oversight, privacy, security and other applicable areas
Ability to analyze and interpret data, and prepare concise, accurate reports
Ability to make strategic and tactical recommendations
Preferred Skills and Qualifications
Masters/JD degree
Summary
The Manager of Commercial Compliance is responsible for providing effective leadership for Sharp Health Plan in the areas of: federal and State legislative analysis and implementation; regulatory affairs, government relations, compliance, privacy, security, fraud/waste/abuse; government contracts, including but not limited to CalPERS and Covered California; and delegation oversight. Chairs the Plan?s Compliance Committee.
A day in the life of a Manager of Compliance at Sharp Health Plan will include:
· Develops analyses and recommendations for programs and goals
· Implements project/action plans to ensure Sharp Health Plan?s continued compliance with all applicable legislative, regulatory, contractual and accreditation requirements in a manner that is consistent with the Plan?s vision, mission, and goals
· Develops and maintains subject matter expertise on contractual, legislative and regulatory issues affecting health plans in California
· Establishes communication plans to ensure that Plan staff, leaders and delegated entities understand and comply with contractual, legislative and regulatory requirements
· Responsible for ensuring the implementation of such contract requirements, laws and regulations
· Directs follow-up assessment of implementations and ongoing activities
· Develops organizational policies and procedures in support of compliance
· Interacts effectively with various internal and external departments to provide guidance, information, and assistance
· Efficiently and effectively documents information and activities for use in communication, education, and monitoring
· Presents reports on compliance activities to the President/Chief Executive Officer and Board of Directors
· Promotes the satisfaction, development, and productivity of the Regulatory Affairs staff
· Participates as part of, and in support of, a management team that works collaboratively to ensure the success of Sharp Health Plan?s goals, objectives, and strategic initiatives
This might be the job for you if you have:
· High level of integrity; ability to exercise sound judgment and maintain confidentiality.
· Exceptional diplomacy skills to effectively resolve issues under sometimes stressful circumstances
· Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity
· Excellent organizational and time management skills
· Excellent business acumen and writing skills
· Experience with electronic mail, word processing, spreadsheets, database programs and Internet research
· Effective interpersonal skills; excellent oral and written communication skills
· Professional presentation skills including public speaking
· Able to represent Sharp Health Plan effectively in dealings with peers and executives (internal and external), legislators, regulators, consultants, vendors and other outside parties who contribute to the success of Sharp Health Plan
Job Type: Full-time
Required education:
Bachelor's
Required experience:
Healthcare Compliance Management: 3 years
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