Compliance Consultant IV , Commercial Health Plan Compliance

Kaiser Permanente International; Pasadena (CA); On-site; USD 110,000 - 160,000; Full time

Job summary

Kaiser Permanente is seeking an experienced compliance professional to conduct company-wide compliance activities in collaboration with internal and external stakeholders. The role includes developing reports, conducting investigations, coordinating regulatory changes, and supporting cross-functional project management.

The ideal candidate will bring a degree in health care or related field and at least six years of compliance or health care operations experience, with strong analytical and

Qualifications

• Bachelor's degree required and minimum six (6) years of experience in compliance, health care operations, audit, finance, regulatory or related fields; equivalent work experience may substitute for the degree.

Responsibilities

• Performs company compliance activities by collaborating with internal and external stakeholders; applies regulations and standards; advises on strategic compliance initiatives; documents activities.
• Develops compliance reports by evaluating data and risk indicators; informs management about compliance drivers, liabilities, and performance metrics.
• Conducts compliance investigations by collecting data, interviewing, researching issues, and proposing corrective actions.
• Supports project management within compliance components of cross-functional programs; coordinates resources and schedules.
• Monitors regulatory changes and analyzes impacts; helps implement designated changes to ensure ongoing compliance.
• Coordinates implementation by identifying requirements, assessing current gaps, creating policies, training, and monitoring adherence.
• Promotes self-development and cross-functional learning; builds relationships and facilitates effective collaboration across teams.
• Assists with planning and coordination of compliance-related projects and stakeholder communications.
• Assists with development and coordination of plans and monitoring across initiatives.

Skills

Attention to Detail

Communication

Critical Thinking

Cross-Group Collaboration

Decision Making

Teamwork

Problem Solving

Learning Agility

Education

Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field

Job description

Job Summary:

This individual contributor is primarily responsible for conducting company compliance activities in collaboration with internal and external stakeholders. Responsibilities include developing compliance reports, conducting compliance investigations, coordinating implementation of compliance efforts, and assisting with regulatory compliance through monitoring regulatory changes. This individual contributor also assists with and supports management of projects including assisting in development and coordination of plans and coordinating with stakeholders.

Essential Responsibilities:

• Practices self-development and promotes learning in others by proactively providing information, resources, advice, and expertise with coworkers and customers; building relationships with cross-functional stakeholders; influencing others through technical explanations and examples; adapting to competing demands and new responsibilities; listening and responding to, seeking, and addressing performance feedback; providing feedback to others; creating and executing plans to capitalize on strengths and develop weaknesses; supporting team collaboration; and adapting to and learning from change, difficulties, and feedback.
• Completes work assignments and supports business-specific projects by applying expertise in subject area; supporting the development of work plans to meet business priorities and deadlines; ensuring team follows all procedures and policies; coordinating resources to accomplish priorities and deadlines; collaborating cross-functionally to make effective business decisions; solving complex problems; escalating high priority issues or risks as appropriate; and recognizing and capitalizing on improvement opportunities.
• Conducts company compliance activities by collaborating with internal and external stakeholders; applying established regulations and standards to compliance efforts; providing insight and recommendations for the design, development, and execution of strategic compliance initiatives; and documenting compliance activities.
• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations); and developing draft presentations to convey key findings.
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential action steps; and providing input for the creation of corrective action plans for substantiated allegations.
• Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts.
• Assists with ensuring regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts; and supporting the implementation of designated changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the current state of compliance to identify gaps and corrective actions; creating or revising moderately complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

Knowledge, Skills and Abilities: (Core)

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

• Analytical Skills
• Compliance Management
• Cross Department Coordination
• Getting Work Done Through Others
• Negotiation
• Project Management
• Technical Communication
• Written Communication

Minimum Qualifications:

• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum six (6) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

Preferred Qualifications:

• Four (4) years experience in health plan compliance.
• Four (4) years experience in health plan operations.
• Three (3) years experience working cross-functionally across departments, functions, or business lines.
• Three (3) years health care experience.
• Two (2) years project management experience.
• Two (2) years experience in a leadership role with or without direct reports.