Talent.com
Senior Compliance Advisor
Senior Compliance AdvisorCommunity Health Plan of Imperial Valley • Imperial, CA, US
Senior Compliance Advisor

Senior Compliance Advisor

Community Health Plan of Imperial Valley • Imperial, CA, US
job_description.job_card.30_days_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
  • serp_jobs.filters_job_card.quick_apply
job_description.job_card.job_description

Community Health Plan of Imperial Valley (CHPIV) is Imperial County's Medi-Cal managed care plan.

We are a locally managed public health care plan committed to working with members, providers, and the residents of Imperial County.

As we continue to build something great, we are looking for a Senior Compliance Advisor to stay current on current and emerging regulations related to our business and assist with drafting policies and procedures.

Our next team member will do the following :

  • Serve as a direct liaison between CHPIV and regulatory agencies, representing the organization in all compliance-related matters with professionalism and expertise.
  • This includes preparing and delivering well-crafted written communications, engaging in clear oral discussions, and effectively addressing regulatory inquiries, audits, and compliance reviews.
  • Develop and implement critical components of the Compliance Program including policies, procedures, training, and monitoring systems, to ensure organizational adherence to regulatory requirements and industry standards.
  • Prepare, develop, and manage regulatory submissions to ensure timely and accurate compliance with applicable requirements, including responses to inquiries and filings with regulatory agencies.
  • Review, approve and recommend revisions to policies and procedures, member and provider materials, and other key documents to ensure compliance with regulatory requirements.
  • Collaborate with regulators throughout the submission and review process to address feedback and secure approvals.
  • Analyze and interpret contractual, state, and federal regulatory requirements.
  • Synthesize complex information into clear, concise summaries that are easily understood by both internal and external stakeholders.
  • This includes presenting requirements in a manner that facilitates decision-making and ensures alignment across all parties involved.
  • Review and evaluate implementation plans to ensure they align with regulatory requirements and incorporate any applicable changes.
  • This includes identifying gaps, providing recommendations, and ensuring compliance is maintained throughout the implementation process.
  • Lead the management of external state and federal regulatory audits by coordinating preparation activities, managing audit processes, and serving as a primary liaison with regulatory agencies to ensure successful outcomes and address any findings effectively.
  • Conduct comprehensive risk assessments to identify potential compliance issues, evaluating impact, and recommending actionable solutions to mitigate risk while ensuring adherence to regulatory requirements.
  • Facilitate cross-functional teams including internal business units and / or external entities to correct performance deficiencies.
  • Develop comprehensive presentations and materials for the Compliance & Policy Committee and Regulatory Compliance Oversight Committee of the Commission, effectively communicating key compliance updates, trends, data reports, risk assessments, and strategic initiatives.
  • Prepare executive summaries that distill complex regulatory information into concise actionable insights, tailored for senior leadership and key stakeholders to support informed decision-making.

You may be right for this job if you have the following :

  • Bachelor's degree in Public Health or Health Care Management from an accredited college or university; or equivalent education / experience in a related area.  In lieu of a degree, relevant experience may be considered.
  • Excellent written and verbal communication skills.
  • Knowledge of health care compliance. 3-5 years in a Medi-Cal managed care setting or with an IPA.  Ability to manage multiple priorities and projects and meet deadlines.
  • Knowledge of Medi-Cal Managed Care principles and / or government programs.
  • Working knowledge of DHCS and Knox-Keene requirements, as well as highly developed analytical and critical thinking skills, to serve as a resource to internal business units and delegates.

    • Our commitment to you :

  • A competitive salary of $80,000-$90,000 / year Health, dental, and vision insurance Paid time off A 401k plan with a generous match A chance to make a real difference in the Imperial Valley community Preference will be given to candidates who are local to Imperial, California, but remote candidates living in California will also be considered.
  • We are an equal-opportunity employer.
  • We celebrate diversity and are committed to creating an inclusive environment for all employees.
  • Powered by JazzHR
    • serp_jobs.job_alerts.create_a_job

    Compliance Advisor • Imperial, CA, US