Operations Policy Specialist & Copyeditor

This role is open to California residents only.

About the role

The Operations Policy Specialist and Copy Editor is responsible for the development, maintenance, governance, review, and continuous improvement of departmental policies and procedures within Gold Coast Health Plan's policy management system. This position serves as the designated owner of Operations policies and procedures, ensuring all documentation remains current, compliant, audit-ready, and aligned with federal, state, accreditation, and organizational requirements. This role will also serve as a primary and/or supporting author and reviewer for departmental documentation like desk-level procedures (DLP), job aid manuals (JAM), standard operating procedures (SOP), training materials, or other operational documentation.

The ideal candidate possesses extensive experience within a Medi-Cal managed care plan and/or Dual Eligible Special Needs Plan (D-SNP) environment with demonstrated expertise interpreting, translating, and maintaining operational policy requirements driven by the California Department of Health Care Services, Centers for Medicare & Medicaid Services, NCQA, and other applicable regulatory and contractual obligations. This individual will partner closely with Operations leaders, Compliance, Regulatory Affairs, and subject matter experts to ensure policies accurately reflect operational practices and regulatory expectations.

Responsibilities

• Policy and Procedure Governance
  • Serve as the primary owner and administrator of Operations policies and procedures maintained within the organization's policy management application.
  • Coordinate the creation, revision, review, approval, publication, and retirement of departmental policies and procedures.
  • Maintain an accurate inventory of Operations policies and procedures and ensure all required review cycles are completed timely.
  • Establish and maintain document version control, review schedules, approval workflows, and governance standards.
  • Monitor policy and procedure compliance with organizational requirements and established documentation standards.
  • Ensure all policies and procedures remain audit-ready and readily accessible.
• Regulatory and Compliance Oversight
  • Maintain knowledge of regulatory requirements affecting Operations functions, including Medi-Cal, D-SNP, Medicare Advantage, and managed care operations.
  • Analyze changes in regulatory, contractual, accreditation, and operational requirements and incorporate necessary updates into policies and procedures.
  • Ensure policies accurately reflect requirements issued by:
    • DHCS
    • CMS
    • NCQA
    • State and federal regulatory agencies
    • Internal organizational governance bodies
  • Support departmental readiness for audits, accreditation reviews, regulatory examinations, and compliance assessments.
• Writing, Editing, and Quality Review
  • Draft, edit, and maintain policy and procedure content using clear, concise, and consistent language.
  • Perform detailed copyediting and quality assurance reviews of Operations policies and procedures as well as JAMs, DLPs, and SOPs.
  • Ensure consistency in terminology, formatting, structure, readability, and policy language across all Operations documentation.
  • Validate policy content through collaboration with subject matter experts and operational leaders.
  • Recommend improvements to policy clarity, organization, and usability.
• Stakeholder Collaboration
  • Facilitate policy review and update discussions with Operations leadership and subject matter experts.
  • Coordinate policy approvals and publication activities.
  • Provide consultation and editorial guidance regarding policy alignment for related operational documentation.
  • Serve as a departmental resource for policy interpretation, organization, and documentation standards.

Requirements

Education & Experience:

• Bachelor’s degree in Healthcare Administration, Business, English, Journalism, or a related field (or equivalent work experience).
• Preferred but not required: 5-7 years of experience in health plan operations, vendor oversight, or compliance.

Equivalent in lieu of degree:

• Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.
• Minimum 3-5 years of experience in Managed Healthcare Operations and/or Government Relations/Compliance must be added in lieu of a bachelor’s degree.

Skills

Preferred Qualifications:

• Strong understanding of Medi-Cal and/or Medicare managed care requirements.
• Experience in a lead or senior role preferred.
• Strong written and verbal communication skills.
• Ability to manage multiple priorities and meet deadlines.
• Data analysis and reporting skills required.

Technology & Software Skills:

• Advanced computer skills in MS Office products.

Competency Statements:

• Management Skills - Ability to organize and direct oneself and effectively supervise others.
• Business Acumen - Ability to grasp and understand business concepts and issues.
• Decision Making - Ability to make critical decisions while following company procedures.
• Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
• Interpersonal - Ability to get along well with a variety of personalities and individuals.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
• Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
• Consensus Building - Ability to bring about group solidarity to achieve a goal.
• Relationship Building - Ability to effectively build relationships with customers and co-workers.
• Presentation Skills - Ability to effectively present information publicly.
• Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
• Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
• Judgment - The ability to formulate a sound decision using the available information.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Communication, Written - Ability to communicate in writing clearly and concisely.
• Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.