Manager Regulatory Affairs and Compliance, Covered California

CalOptima; Orange (CA); Hybrid; USD 110,000 - 176,000; Full time

Benefits offered by this job

Partial Telework

Generous PTO

Tuition Reimbursement

Flexible scheduling

Career development opportunities

Job summary

CalOptima seeks a Manager of Regulatory Affairs and Compliance (Covered California) to lead our Office of Compliance. You will manage relationships with Covered California, DMHC and CMS, ensuring regulatory obligations are met across the organization and directing audit readiness and corrective actions.

The role blends leadership with regulatory oversight, requiring collaboration with leadership and staff to advance CalOptima Health's mission and responsibilities within California's health

Qualifications

• Bachelor's degree in a health care related field with 5 years of regulatory experience in health plans or similar.
• 3 years of compliance experience focused on Covered California within a managed care setting.
• 3 years of progressive leadership or supervisory experience.

Responsibilities

• Lead and develop the Regulatory Affairs and Compliance team for the Covered California program.
• Serve as regulatory liaison with Covered California, DMHC and CMS, managing communications and audits.
• Oversee regulatory filings, reporting, audits, and corrective action plans for compliance.
• Monitor statutory and regulatory updates and ensure timely impact analyses.
• Collaborate with executives and other departments to meet regulatory obligations.

Skills

Regulatory affairs

Compliance leadership

Project management

Communication skills

Education

Bachelor's degree in health care field

Master's degree (preferred)

Job description

Manager Regulatory Affairs and Compliance, Covered California

CalOptima

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 CalOptima 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 CalOptima Health's contractual, statutory and regulatory obligations with Covered California, DMHC and CMS with respect to CalOptima Health's Covered California program. You will work with leadership to ensure that CalOptima Health's strategic goals and objectives are communicated with regulatory agencies and that CalOptima Health's reputation with regulatory agencies is maintained. You will interact with CalOptima 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 CalOptima Health's departments in response to regulatory inquiries, problem solving and promoting CalOptima 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 CalOptima Health's management, Board of Directors and Compliance Committee related to regulatory affairs and compliance activities.
• Represents CalOptima Health at various internal and external meetings.
• 45% - Program Oversight
• Serves as CalOptima 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 California program.
• Manages all activities related to Covered California regulatory audits.
• Manages all audit preparation activities related to regulatory audits to ensure audit readiness.
• Manages the issuance of corrective action plans for issues of non-compliance related to CalOptima Health's Covered California program, whether from regulatory audit findings or compliance investigations.
• Manages the process for validation of all activities required for regulatory compliance.
• 5% - Completes other projects and duties as assigned.

Do You Have What the Role Requires

• Bachelor's degree in a health care related field PLUS 5 years of experience with regulatory agencies, health plans and/or the health care industry, including interacting with governmental requirements and regulations on behalf of a managed care organization required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
• 3 years of compliance experience focused on Covered California within a managed care health plan required.
• 3 years of progressive leadership, lead or supervisory level experience required.
• Have access to means of transportation for work away from the primary office approximately 5% of the time required.

You'll Stand Out More If You Possess the Following

• Master's degree.
• Experience in compliance program monitoring and enforcement of regulatory guidance through corrective action/remediation plans.

What the Regulatory Agencies Need You to Possess

N/A

Your Knowledge & Abilities to Bring to this Role

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize 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.

Your Physical Requirements (With or Without Accommodations)

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You'll enjoy competitive compensation for this role.
• Our current hiring range is: Pay Grade: 315 - $109,892 - $175,827 ($52.83 - $84.5322).
• The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
• This position is approved for Partial Telework (**If the position is Telework, it is eligible in California only**)
• A https://www.caloptima.org/en/careers#benefits
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:

• A generous PTO program
• A quality work life balance
• Various wellness programs
• Tuition Reimbursement
• Professional development opportunities
• Career development opportunities
• Flexible scheduling
• And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment

• If located at the 500, 505 Building or a remote work location:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.
• If located at PACE:
• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.
• If located in the Community:
• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

Our Commitment to You

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.