Compliance Manager

We have an opportunity to join the Alliance as the Compliance Manager leading a team in the Compliance Department.

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Compliance Director, this position will manage the Compliance function, act as a subject matter expert, maintain, and monitor the Compliance Plan, and provide guidance on Compliance functions and departmental operations in a proactive and collaborative manner. This person will also manage the Risk Assessment and Internal Audit and Monitoring Program, provide regulatory audit support, and manage the Alliance's external regulatory audit functions and the Delegate Oversight Program. In addition, this person will manage, lead, supervise, mentor, and train assigned staff.

ABOUT THE TEAM

The Compliance Division interprets requirements, mitigates risk, and holds stakeholders accountable, protecting the organization's integrity and member access to quality healthcare.

We are the team that helps employees understand and follow the complex rules and requirements to meet our important compliance obligations. In short, we define and support the Alliance's Culture of Compliance internally and with our external healthcare partners. We perform internal audits and monitoring to help us maintain a compliance program that is always up-to-date with ever-evolving compliance rules and obligations. We also handle and investigate internal concerns related to HIPAA, fraud, waste, and abuse, and conduct prevention and detection activities.

THE IDEAL CANDIDATE

• Is proactive; takes initiative and works effectively with others to achieve common goals
• Is open to learning new technologies, particularly in AI software and workflow automation
• Is adaptable to change, and new processes, with the ability to lead in a dynamic, evolving environment
• Has experience with Risk Assessing, Delegate Oversight, Auditing, Monitoring and NCQA standards
• Is comfortable handling difficult conversations, adjusting communication style to different personalities, and audiences within the organization
• Has experience in public speaking and facilitating group interactions, with the ability to engage both small and large audiences effectively
• Works well as part of a team, fostering collaboration and maintaining open, proactive communication

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description and list of requirements click here.

• Knowledge of:
• • Principles and techniques associated with healthcare compliance functions
  • Principles and practices of health care planning and administration
  • Healthcare regulatory policies
  • Methods and techniques of research, analysis, and reporting
  • Medi-Cal, Medicare, Public Assistance and/or Social Security programs
• Ability to:
  • Train, mentor, supervise, and evaluate the work of staff, promote an atmosphere of teamwork and cooperation, and motivate staff to achieve goals and objectives
  • Develop work plans and workflows, organize and prioritize Compliance activities
  • Act as a technical resource and interpret, apply and explain complex principles, policies, procedures, regulations, terms, processes, and programs related to area of assignment
  • Provide leadership, facilitate and lead meetings and projects, and guide employees in the resolution of issues
  • Manage the development and implementation of projects, systems, programs, policies, and procedures
• Education and Experience:
  • Bachelor's degree in Business or Public Administration, Health Care Administration, Public Policy, or a related field and a minimum of six years of compliance-related experience in the healthcare industry which included some lead or supervisory responsibility (a Master's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferrable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area