About this role
Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)
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 Compliance Advisor II ensures L.A. Care business units are compliant with all Product Lines' contractual, state and federal regulatory, and accreditation requirements. The Compliance Advisor develops regulatory submissions, reports, agendas and communications to the Internal Compliance Committee and the Compliance and Quality Committee of the Board of Governors and provides support for the management of external state and federal regulatory audits. The Compliance Advisor prepares executive summaries and reports, develops and conducts training activities for subordinates, peers and L.A. Care business units and participates in interdisciplinary/cross-functional teams.
The Compliance Advisor may investigate, assist with coordination and management of teams and workgroups, project documentation and workflows, draft and complete presentations, auditing and monitoring of performance standards, and other duties as assigned. Although the Compliance Advisor's primary responsibility is providing support and for the Regulatory Compliance unit, the Advisor also advises and supports the Manager, Director, and Chief Compliance Officer on other duties as assigned to support the mission and responsibilities of the Compliance Department and to support the business operations of L.A. Care Health Plan.
Duties
Analyze and interpret contractual, state and federal regulatory, and accreditation requirements.
Participate in and conduct compliance functions, including, but not limited to, developing compliance tools and validating implementation of new requirements and corrective action plans.
Work with internal business units to prepare reports for distribution to internal Committees and external entities.
Facilitate cross-functional teams including internal business units and/or external entities to correct performance deficiencies.
Prepare and conduct trainings for internal business units and/or external entities.
Review, approve and suggest revisions on policies and procedures, member/provider materials, compliance work plans, etc., as well as submit to regulatory entities for approval.
Work with internal business units to identify gaps, develop and implement corrective action plans and facilitate monitoring activities to ensure compliance with regulatory requirements.
Review internal and external inquiries and collaborate with all levels of organizational management, business units and our Delegates to ensure timely, accurate, and complete submissions. This includes self-disclosures of non-compliance issues to the regulators.
Develop, maintain, and monitor Internal Compliance Committee (ICC) Charter, Compliance Program and key performance indicators. Responsible for the development of Board/committee write-ups to be presented at the Compliance & Quality (C&Q) and Internal Compliance Committee (ICC) meetings.
Perform other duties as assigned.
Duties Continued
Education Required
Education Preferred
Experience
Required:
At least 3 years of experience in a managed care setting.
Experience in health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management (UM) and so forth) and developing audit tools.
Demonstrated experience developing and delivering training programs and making presentations.
Preferred:
2 years of Medi-Cal, Medicare or commercial product compliance. Regulatory change management and risk management experience and/or business continuity experience in a health plan or hospital setting preferred.
Skills
Required:
Excellent written and verbal communication skills.
Knowledge in health care compliance.
Ability to manage multiple priorities and projects and meet deadlines.
Knowledge of Medi-Cal Managed Care principles and/or government programs.
Persuasion Skills: 1. Ensuring organizational compliance with all state and federal Medi-Cal Program requirements reduces L.A. Care's risk to state/federal sanctions and fines- communicate required action to senior management/Board of Governor (BoG), Plan Partner staff. 2. Internal audit program and internal reviews are indicators of the quality of health care services provided to L.A. Care Medi-Cal members. This serves to help maintain a quality and solvent provider network and avert provider network disruptions due to poor quality of care and/or insolvent providers. All areas of risk/noncompliance are to be identified, reported and monitored.
Working knowledge of California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and Knox-Keene requirements, as well as highly developed analytical and critical thinking skills, to serve as a resource to internal business units and external entities.
Preferred:
Advanced skills in Visio, PowerPoint and/or SharePoint preferred.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
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
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
Other facts
About L.A. Care Health Plan
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)
What you'll do
- The Compliance Advisor II ensures compliance with contractual, state and federal regulatory, and accreditation requirements. They develop regulatory submissions, prepare reports, and conduct training for internal business units.
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