Chief Regulatory Affairs & Compliance Officer

About the role

The Chief Regulatory Affairs and Compliance Officer will oversee the Health Plan’s regulatory affairs and compliance program, including fraud, waste and abuse prevention. This role also involves managing the legal department and outside counsel, developing policies and procedures, and overseeing compliance programs.

Responsibilities

• Oversee the selection, retention, management and evaluation of all outside counsel.
• Recommends, develops and defines the health plan’s policies and procedures.
• Provides guidance on the legal impact of new or proposed local, state, federal or managed care legislation.
• Evaluates and plans for remediation of enterprise risk related matters as issues and initiatives arise.
• Develops and maintains relationships with internal and external stakeholders, including federal and state regulators and trade associations.
• Identifies, develops, and implements or oversees the implementation of strategies; oversees the development of associated business plans.
• Develops and is responsible for the implementation and oversight of HPSJ’s Compliance Program, Anti-Fraud Plan, and Annual Compliance Work Plan.
• Chairs the Compliance Committee and ensures the committee meets the goals as outlined in the HPSJ Compliance Plan and Annual Compliance Work Plan; ensures all sub-committees to the Compliance Committees (when necessary) are formed and operate on a regular basis to meet their intent.
• Maintains and monitors the performance of the compliance program, including privacy and fraud, waste and abuse, and related activities on a continuing basis.
• Develops and conducts compliance and related training programs and activities for the Health Plan employees and vendors in an effective and timely manner.
• Fosters a work environment that respects the importance of the privacy of member, client, and employee information.
• Hires, develops, and retains staff and ensures that direct reports hire, supervise, and retain competent staff.

Requirements

• At least eight years of healthcare regulatory experience; and Experience with Medi-Cal and/or Medicare managed care program requirements; and Experience working closely with internal and external leadership; and Six years as a Compliance Manager in a California health plan, including state-sponsored programs;
• Master's degree in Health Administration, Public Health, Regulatory Affairs, Business Administration, or other related fields.

Qualifications

• Expert knowledge of applicable federal and state privacy laws, regulations and standards, including state sponsored programs, applicable to health plans.
• In depth knowledge of health plan operations as they relate to compliance.
• In-depth knowledge of standard contract components and contract language specific to healthcare.
• In-depth knowledge of health information systems and their impact on privacy issues.
• In-depth knowledge of audit, control and monitoring processes, and the ability to effectively implement and maintain them.
• Strategic mindset: Sees ahead to future possibilities and translates them into breakthrough strategies; identifies, plans, leads and executes to meet changing organizational and community needs, and regulatory requirements.
• Cultivates innovation: Creates new and better ways for the organization to be successful.
• Drives results: Consistently achieves results, even under tough circumstances.
• Drives engagement: Creates a climate where people are motivated to do their best to help the organization achieve its objectives.
• Drives vision and purpose: Paints a compelling picture of the vision and strategy that motivates others to action.
• Courage: Steps up to address difficult issues, says what needs to be said.
• Nimble learning: Actively learns through experimentation when tackling new problems, uses both successes and failures as learning fodder.
• Situational adaptability: Adapts approach and demeanor in real time to match the shifting demands of different situations.
• Strong skills in budget development and management.
• Communicates effectively: Develops and delivers multi-mode communications that convey a clear understanding of the unique needs of different audiences.
• Very strong presentation skills, with the ability to tailor presentations to a specific audience, and address and interact with large groups.
• Very strong interpersonal skills, with the ability to establish and maintain effective working relationships with diverse individuals at all levels inside and outside of HPSJ.
• Very strong collaboration skills, with demonstrated ability to create and foster a collaborative work environment, maintain effective, high-performance teams, and organize people and resources to solve problems and identify business opportunities.
• Very strong assessment and analytical skills, including the ability to synthesize, distill concepts, draw conclusions and identify implications.
• Manages complexity: Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
• Resourcefulness: Secures and deploys resources effectively and efficiently; organizes people and resources to solve problems and identify opportunities.
• Plans and aligns: Plans and prioritizes work for self and others to meet commitments aligned with organizational goals.
• Very strong project management skills, with the ability to function as a sponsor and owner on complex projects; a track record of successful large project implementations.
• Strong customer service orientation.
• Ensures accountability: Holds self and others accountable to meet commitments.
• Strong knowledge of change management theory, with ability to anticipate and implement effectively.
• Promotes, maintains, and ensures that direct reports promote and maintain an environment that supports HPSJ’s strategy, vision, mission and values.
• Very strong coaching/counseling skills, including the ability to function as a mentor to management and employees.
• Ability to supervise staff and ensure that direct reports supervise staff in a manner that maximizes employee performance and business results.
• Ability to treat confidential information with appropriate discretion.

Skills

• Knowledge of the managed care industry, its products, services and major business processes.
• Knowledge of federal and state and federal regulations applicable to managed care.

Benefits

The Health Plan offers a comprehensive benefits package including robust and affordable medical coverage, employee wellness programs, generous paid time off, CalPERS retirement pension program, and more.

Pay

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

Schedule

Work may be performed in a remote, hybrid, or onsite setting depending on the requirements of the position and business needs.