Overview

This position serves as the subject matter expert in regulatory compliance supporting internal and external audit functions as well as leading project management efforts. This position reports to the Chief Compliance Officer & SVP of Regulatory Affairs.

The Regulatory Compliance Project Manager will have knowledge and experience with the California health plan regulatory requirements in the commercial market, specifically the requirements applicable to Knox-Keene plans licensed by the Department of Managed Health Care (DMHC). Additionally, the ideal candidate will have experience with or hands on working experience with internal audit and external delegation oversight audit requirements applicable to DMHC-licensed health plans, including oversight of the contractual requirements specified in delegation agreements for DMHC-licensed, NCQA-accredited plans. 

The Regulatory Compliance Project Manager is responsible for effective, timely, accurate, and well documented project plans for both internal and external customers. Successful project management experience with creating project plans, evaluating, and documenting project processes, determining deadlines, identifying process barriers, and facilitating problem resolution.

The successful candidate will possess sufficient experience in regulatory compliance to independently assess client documentation to ascertain compliance with relevant standards and audit requirements. Superior critical thinking skills and strong attention to detail with a record of competency are required. Independently managing and executing tasks while communicating need for assistance and or guidance is expected. This position requires the ability to determine and communicate project status to internal and external stakeholders.

Essential Job Functions

• Assist in developing internal and external delegation oversight audit protocols (per the California DMHC rules applicable to commercial health plans and contractual requirements). 
• Perform and co-lead internal and external delegation oversight audits. Typical areas include utilization management, appeals & grievances, quality assurance, claims, etc. (training and guidance are provided for unknown areas).
• Assist in the development of a compliance monitoring program to ensure adherence to regulatory requirements impacting various operational areas. 
• Receive, monitor, research, and assess documentation for compliance to established standards.
• Assist in oversight of work performed by delegated entities to ensure compliance with regulatory and contractual requirements. 
• Assist in reviewing and preparing delegate and regulatory responses under the supervision of the manager.
• Coordinate meetings, create and manage meeting agendas and meeting notes.
• Create and maintain client dashboard reporting.
• Create, manage, and actively monitor project plans to meet project goals and adhere to responsibilities and project milestones. 
• Build strong relationships with colleagues and business partners to mitigate compliance risks. 
• Lead in the research, analysis, identification, and evaluation of data to assess existing and potential trends and issues
• Excellent analytical, planning, problem-solving, verbal, and written skills to communicate complex ideas.
• Strong facilitation, collaboration, and teamwork skills with the ability to build cross-functional partnerships to drive results.
• Utilize a proactive approach to ensure all project milestones and deadlines are met.
• Ability to work with minimal supervision and independently to implement business process improvements. 
• Seek assistance when needed and demonstrates a willingness to learn new skills. 

Qualifications

Education/Certification

• BA/BS 
• Or equivalent combination of education and/or work experience may be substituted.

Required Relevant Work Experience

• 4 years of experience with regulatory affairs related to health care systems, or 2 years managing complex projects for high profile clients.
• 2 years of project management experience (preferrable in a healthcare setting).
• MS Office Suite proficiency 
• 2 years of California Department of Managed Health Care (DMHC) regulatory compliance experience
• 2 years of California managed care (health plan, provider group, etc.) delegation oversight experience (compliance audits, reports, etc.)

Specialized Knowledge, Skills, and Abilities

• 2 years of experience and skill in word processing, basic spreadsheet and presentation software applications; familiarity with database software programs (Microsoft Office 365, PM tools, Adobe Acrobat).
• Excellent oral, written, interpersonal and problem-solving skills.
• Adept at communicating at all levels within the company.
• Knowledge of healthcare delivery systems and managed care operations.

Preferred

• Proficient with Project Management Software (Smartsheet, Lucid, or Canva).

Position Details:

• Position Type: 6 Month Contract to Hire
• Pay: $31- 41 per hour
• Expected Hours: 20-40 per week
• Work Location: Remote 

To apply at QMetrics, please email your resume to info@qmetrics.us.