Job Abstract

The Manager, Regulatory Affairs serves as a senior leader within the Compliance Department. The Manager manages the Regulatory Affairs unit, including managing the relationships with state and federal regulatory agencies and leading communication between L.A. Care business units regarding potential risks and/or deficiencies in order to proactively prevent and correct non-compliance issues. In addition, the Manager maintains an enterprise-wide monitoring program to ensure ongoing compliance and regulatory audit readiness. The Manager develops regulatory reports, agendas, minutes and communications to the Internal Compliance Committee and the Compliance and Quality Committee of the Board of Governors. The Manager prepares executive summaries and reports, develops and conducts training activities for subordinates, peers and L.A. Care business units and leads or participates in interdisciplinary/cross-functional teams. Although the Manager's primary responsibility is management of the Regulatory Affairs unit, the Manager also advises and supports the Directors and Chief Compliance Officer on other duties as assigned to support the mission and responsibilities of the Compliance Department and to support the mission and business operations of L.A. Care Health Plan. The Manager manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Manage day to day operations and activities of the team, including the hiring and supervision of staff and evaluation of staff performance. Provide direction to staff on projects, resolve and respond to questions and issues raised by senior management, staff, providers and third-parties. Continually assess technical and other job-related skills and knowledge of staff, and deploy needed training. Develop, implement and monitor ongoing employee engagement plans.

Draft and timely revise policies and procedures, desk-top manuals and other guidance for effective and efficient administration of team functions. Lead special projects as needed.

Serve on, lead and facilitate in cross-functional workgroups and meetings, including preparing and supporting presentations, reports, data and recommendations.

Ensures that ad-hoc and routine inquiries or issues regarding member care, regulatory guidance analysis, and plan performance are addressed promptly. In addition, the Manager will leverage new opportunities to interface with regulatory agencies to promote visibility of the Plan and member priorities and maintain a system to track and trend regulatory priorities

Ensure compliance with all organizational, contractual, regulatory, and accreditation standards applicable to the functions under Manager.

Perform other duties as assigned.

Required:

At least 5 years of health care or related experience designing, implementing compliance programs, policies and practices: and/or managed health plan/managed care business operations.

At least 3 years of leading staff or supervisory/management experience.

Experience with implementing or supporting the implementation of managed Medicare, Medicaid or commercial regulations.

Equivalency:  Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Required:
Strong organizational and planning skills, including flexibility to handle multiple assignments, changing priorities, and compressed deadlines.  

Proficient in MS Office, including with Word and Excel.

Excellent interpersonal, verbal and written communication skills, including to senior management.

Functions well within the team and matrixed work environment, collaborating effectively with team members and other departments.

Regulatory Agency Management: Manage account management relationships with regulators; this includes collaborating with all levels of organizational management, business units and our Delegates on timely, accurate, and complete submissions. This includes self-disclosures of non-compliance issues to the regulators. The Manager also oversees and maintains a centralized and streamlined information sharing process in order to track and trend communications to identify risk areas and regulatory priorities.

Regulatory Audits and Monitoring: Manage regulatory audits; this includes collaborating with all levels of organizational management, business units, and our Delegates on establishing processes that meet compliance. The Manager oversees and maintains a centralized and streamlined monitoring program to track status of enterprise-wide compliance for high risk and high member impact related measures.