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Turner & Townsend
Construction Project Manager- OAR I- (Anticipated Opening)
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$77k–$124k/yr
Full-time
bachelor degree
Paid Time Off, Tuition Reimbursement, Retirement Plans, Medical Insurance, Dental Insurance, Vision Insurance
Posted 30d ago
~40 hrs/week
Responsibilities
The auditor ensures delegates comply with contractual, state, and federal regulatory requirements by conducting audits and monitoring performance standards. They collaborate with cross-functional teams to address compliance challenges and deliver regulatory training to internal and external stakeholders.
Requirements
Candidates must have at least 3 years of audit experience in compliance or delegation oversight within the healthcare industry. A bachelor's degree is required, along with demonstrated knowledge of DHCS, CMS, and NCQA regulatory standards.
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
Job Summary
The Delegation Oversight Compliance Auditor II ensures delegates are compliant with all Product Lines contractual, state, and federal regulatory, and accreditation requirements. This position serves as a resource to internal business units and external entities by providing working knowledge of California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) requirements. The position conducts audits, investigates, assists with coordination and management of teams and workgroups, creates project documentation and workflows, drafts presentations, audits, and monitors performance standards.
Duties
Analyzes and interprets contractual, state, and federal regulatory, and accreditation requirements. Stays abreast of changes in healthcare regulations, laws, and industry standards; analyzes regulatory developments and assesses their impact on the organization.
Participates in and conducts compliance functions, including, but not limited to, develops compliance audit tools and validates implementation of new requirements and corrective action plans.
Collaborates with cross-functional teams, including Legal, Compliance, Quality Assurance, and Operations, to address compliance-related challenges and implement effective solutions. Works with internal business units to prepare reports for distribution to internal Committees and external entities.
Works with internal business units and/or external entities to correct performance deficiencies.
Delivers regulatory trainings for internal business units and/or external entities.
Facilitates and participates in compliance related projects.
Assists in the development, review, and updating of policies, procedures, guidelines compliance work plans, to ensure alignment with regulatory requirements and industry best practices.
Conducts audits of L.A. Care subcontracted providers including, but not limited to, Participating Physician Groups, Plan Partners, and Specialty Health Plans/Vendors.
Updates existing audit tools based on regulatory changes.
Leads entrance and exit conferences, and technical calls with delegates.
Performs other duties as assigned.
Duties Continued
Education Required
Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.
Education Preferred
Experience
Required:
A least 3 years of audit experience in compliance, delegation oversight, or audit within the healthcare industry.
Demonstrated experience in delivering training programs and making presentations to internal staff and providers.
Skills
Required:
Knowledge of California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA) requirements.
Highly developed analytical and critical thinking skills
Ability to manage multiple priorities, projects and meet deadlines.
Excellent verbal and written communication skills.
Proficient in Microsoft Office, Excel, and PowerPoint.
Knowledge of policies and procedures.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Light
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
L.A. Care’s mission is to provide access to quality health care for L.A. County’s low-income communities, and to support the safety net required to achieve that purpose. As a publicly operated health plan, L.A. Care Health Plan serves more than 2.6 million members in Los Angeles County, making it the largest publicly operated health plan in the country. L.A. Care offers four health coverage plans including Medi-Cal, L.A. Care Covered™, L.A. Care Medicare Plus and the PASC-SEIU Homecare Workers Health Care Plan, all dedicated to being accountable and responsive to members. L.A. Care prioritizes quality, access and inclusion, elevating health care for all of L.A. County. For more information, follow us on X, Facebook, LinkedIn, Instagram and YouTube.
To learn more, visit www.lacare.org.
*For urgent inquiries: 1-888-4LA-CARE (1-888-452-2273)
Offices: 1200 W 7th St, Los Angeles, California 90017, US
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