Manager Regulatory Affairs and Compliance, Covered

Join Us in this Amazing Opportunity

The Team You’ll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Manager Regulatory Affairs and Compliance, Covered California
and help shape the future of healthcare where you’ll be an integral part of our Office of Compliance
team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be
Partial Telework
.

• If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Manager of Regulatory Affairs and Compliance (Covered California) will manage Cal Optima Health’s relationships with regulatory agencies:
Covered California, Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), and Department of Managed Health Care (DMHC). You will ensure the management of Cal Optima Health’s contractual, statutory and regulatory obligations with Covered California, DMHC and CMS with respect to Cal Optima Health’s Covered California program. You will work with leadership to ensure that Cal Optima Health’s strategic goals and objectives are communicated with regulatory agencies and that Cal Optima Health’s reputation with regulatory agencies is maintained.

You will interact with Cal Optima Health’s staff at all levels, health network management staff, state and federal regulators and others as required.

Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 50% - Leadership Functions
  • Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.
  • Interfaces with and responds to state and federal representatives on compliance-related issues, as needed.
  • Hires, manages, trains, supports, develops and evaluates direct reports.
  • Manages the day-to-day activities of staff to ensure proper prioritization of tasks and accurate documentation.
  • Works with all Cal Optima Health’s departments in response to regulatory inquiries, problem solving and promoting Cal Optima Health’s mission and message.
  • Assists in the development and implementation of process improvements of the Regulatory Affairs and Compliance (Covered California) department.
  • Assists in the preparation of updates and reports to Cal Optima Health’s management, Board of Directors and Compliance Committee related to regulatory affairs and compliance activities.
  • Represents Cal Optima Health at various internal and external meetings.
• 45% - Program Oversight
  • Serves as Cal Optima Health’s regulatory liaison with Covered California, DMHC and CMS with regard to its Covered California program by managing all incoming and outgoing communications with regulators.
  • Tracks, monitors and conducts impact analyses for all statutory, regulatory, sub-regulatory and contractual updates for the Covered California program.
  • Manages the submission of all required regulatory filings and reporting requirements with regulators for the Covered…