Regulatory Affairs & Compliance Analyst, Policies & Procedures

About the role

We are seeking a Regulatory Affairs & Compliance Analyst, Policies & Procedures to join our OOC - Policies & Procedures team. This position supports the development, communication, and implementation of CalOptima Health policies and procedures, strengthening our policy framework and ensuring compliance with federal, state, and contractual requirements.

Responsibilities

• Participates in a mission-driven culture of high-quality performance, focusing on member-focused customer service, consistency, dignity, and accountability.
• Assists the team in carrying out department responsibilities and collaborating with others to support short and long-term goals/priorities for the department.
• Maintains and supports existing process tools for policy tracking and development.
• Provides detailed analysis and technical review of CalOptima Health's policies.
• Guides internal customers with policy inquiries and provides recommendations for policy decisions regarding regulatory and contractual requirements.
• Analyzes program policies for compliance with applicable statutory, regulatory, sub-regulatory, contractual, and other CalOptima Health obligations, including state and federal standards and requirements.
• Develops project work plans in support of policy and procedure development.
• Develops regular reports on progress of CalOptima Health's policy reviews and provides evaluations and assessments of results.
• Keeps current on the local, state, and federal health care environment; identifies issues that may impact CalOptima Health's policies and procedures.
• Supports and leads efforts related to policy and procedures for regulatory audits of CalOptima Health's programs.
• Contributes to a positive work environment with productive interactions between staff at all levels and within each stage of the policy review process.

Requirements

• Bachelor's degree in health services administration, public health, public policy or related field PLUS 3 years of experience in the health care industry in a public or regulatory affairs role, including experience in policies and procedures development, required.
• 3 years of experience in Medicare Advantage, Medicare Part D or Cal MediConnect (Medicare-Medicaid) plans or the Program of All-Inclusive Care for the Elderly (PACE) required.

Qualifications

• Master's degree in a related field preferred.

Skills

• Develops rapport and establishes effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Works independently and exercises sound judgment.
• Communicates clearly and concisely, both orally and in writing.
• Works a flexible schedule; available to participate in evening and weekend events.
• Organizes, is analytical, problem-solves, and possesses project management skills.
• Manages multiple projects and identifies opportunities for internal and external collaboration.
• Motivates and leads multi-program teams and external committees/coalitions.
• Utilizes computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Benefits

• Competitive compensation
• CalPERS pension program and additional retirement packages
• A generous PTO program
• Quality work-life balance
• Variety of wellness programs
• Tuition reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling