Associate Director, Quality and Compliance, DentaQuest; California

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop‑loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Denta Quest manages dental and vision benefits for more than 33 million Americans. Our outcomes‑based, cost‑effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Must reside in California

The Associate Director, Quality and Compliance provides operational guidance in the effective delivery of services to clients, members, and stakeholders. Through partnership with operational team leads, the Associate Director collaborates on service delivery, corporate and division strategic priorities and compliance with implementation of all regulatory requirements, including but not limited to quality, fraud, waste and abuse, diversity, equity and inclusion, and civil rights.

This position reports to the director within the Compliance department. This position handles contractual and regulatory quality and compliance for California government program clients. In addition, this position serves as the compliance subject matter expert (SME) to the operational leads in implementation of contractually and regulatorily compliant processes. Administers an organizational quality management system and monitors progress against strategic and contractual quality‑related goals.

• Serves as quality and compliance contact and is responsible for overall compliance with contractual, federal, state and local laws, rules and regulations affecting California Quality and Compliance programs.
• Monitor, research federal and state regulations and proposed regulations to identify applicability for Company and works with Government Relations and Legal to ensure appropriate application of laws and regulations
• Develops training programs to ensure Denta Quest is meeting its legal and contractual obligations
• Coordinates and communicates to internal departments and external clients and vendors, where appropriate, all compliance activities and programs, as well as integrates the California Compliance and Quality Programs into the Company's Compliance Program and Workplan
• Maintain up‑to‑date knowledge of developments in all legislative and regulatory implications for Denta Quest California.
• Oversees the operational aspects of California compliance and Quality, working closely with leadership in operational areas to provide audit and monitoring oversight, as well as information to ensure they know regulatory and contractual requirements.
• Assists operational departments with review of policies and procedures designed to ensure compliance with contract obligations and other applicable requirements
• Develops policies and procedures to ensure Denta Quest's Operations is compliance and assists with the development of policies and procedures specific to operational areas
• Assist account/operational management in responding to health plan and DHCS audits and provide technical assistance to improve performance, as needed and requested
• Oversees implementation of initiatives associated with contractual operational compliance and quality and drives to completion

• Five years' experience in government programs product management, regulatory affairs, operations or other similar healthcare related government programs function preferably in health care/managed care environment
• Up‑to‑date knowledge of state and federal laws and regulations, including Medicare/Medicare…