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Director, Regulatory Strategy & Contracts

Location: Burbank, CA Additional Locations:
Job Number: 814403 Date posted: 08/09/2019
Description:

Develop, manage and implement regulatory strategy to maintain existing product lines or support entry into new markets upon creation of new products. Responsible for the direction and ensuring regulatory compliance with government requirements and KPIC's (or similar department's) contractual obligations in support of the Department's goals and the organization's mission/vision. Develop guidance for adherence of KPIC's (or similar department's) contractual requirements; synchronize with industry standard and other high risk areas. Establishes a strong program for effective partnership with regulatory bodies; national®ional operations; national and regional product development areas; rating and actuarial divisions and national and regional sales and marketing department's. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Researches current and upcoming federal and state regulatory guidelines, laws and statutes; compliance issues and recommends changes and/or analyzes impacts to assure compliance with contract obligations. Acts as point of contact and liaison for all Regulatory Agency audits providing logistical coordination, schedules, requested reports and information and acts as departmental representative in communicating and interfacing within KPIC; with KP's compliance areas and outside agencies on regulatory issues. Ensures all relevant external regulatory requirements are identified and develops processes to disseminate information on regulatory compliance requirements to appropriate personnel. Engage external regulatory and legislative bodies on developing regulations, passage of laws in support of the organization's strategic direction. Plan oversight on regulatory filings and monitoring operation functions such as benefit management and Plan Operations such as enrollment, premium billing, member service, etc, claims processing, and quality improvement.



Essential Functions:


- Direct reports are usually managers.
- Reports to Executive Director or VP.
- Purview is multiple units or departments and/or a geographic or functional area.
- Oversees the implementation of tactical solutions which support strategic plans.
- Drives strategic direction.
- Change Leader.
- Ensures the day to day operation and management of assigned regulatory services, in accordance with contract, all applicable regulatory requirements and laws, and policies and procedures.
- Establishes strategy and tactics within area of responsibility, and may contribute to the formulation of a national strategic goal for KPIC.
- Drives change, process improvements and cultural transformation and acts as change leader.
- Encourages management development by providing opportunities for leadership and working with leaders throughout the organization. Recommends sponsorship opportunities and acts as sponsor.
- Ensures plans in place to accomplish area goals, results tracked and resources appropriately allocated across area of responsibility.
- Monitors the results of functional area and processes.
- Reviews and integrates business processes to achieve business results and appropriate solutions for customers.
- Manages financial aspects of the organizational area; accountable for direct budget.
- May provide financial projections for strategic plans or forecast for future years.
- Manages HR/People processes for the organizational area including performance reviews/management, resource management, planning, objective setting/alignment, employee development/coaching and training.



Additional Responsibilities Include:
1. Support program management responsibilities across the organization for large and complex programs and/or projects
2. Create value and increase program value through efficient delivery using best practice management tools
3. Analyze complex work processes (involving multiple stakeholders or organizations) for improvement opportunities.

 

Basic Qualifications:
Experience
- Minimum eight (8) years of management experience in health care/insurance regulatory compliance environment with minimum three (3) years of management experience required.
Education
- Bachelor's degree in related area.
License, Certification, Registration
- N/A
 
Additional Requirements:
- Experience in managing large regulatory compliance audits and investigations, liaison to government agencies.
- Requires extensive working knowledge of government regulations agencies particularly that of various state's Department of Insurance and/or other agencies such as CMS, (Medicaid) DMHC, (Department of Managed Health Care); Department of Labor (ERISA);DHS (Department of Health Services MediCal) affecting compliance activities required for health care administration; and thorough knowledge on HIPAA issues and requirements.
- Demonstrated ability in performing thorough investigations, developing logical conclusions and effective analytical reports, complex problem solving and high-level negotiations.
- Must be able to work in a Labor/Management Partnership environment.
 

Preferred Qualifications:
- Advanced degree in related area preferred.
- Paralegal or law degree preferred.

 

Additional Description to Include:
1. Support program management responsibilities across the organization for large and complex programs and/or projects
2. Create value and increase program value through efficient delivery using best practice management tools
3. Analyze complex work processes (involving multiple stakeholders or organizations) for improvement opportunities.

 

Primary Location: California,Burbank,Marketing Sales Service and Admin 3100 Thornton Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 4:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Director/Senior Director Job Category: Sales and Marketing Department: California MediCal State & Sponsored Programs Travel: Yes, 10 % of the Time Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.

About Sales & Marketing

Careers In Sales & Marketing

Apply your sales, account management, marketing, and product development skills as a member of our high-performing team. Kaiser Permanente's unique stance as an insurance provider and care delivery organization provides the key differentiation that rests at the core of our offering. This, coupled with an unwavering commitment to health advocacy and total health, drives our marketing and sales strategies — and it's what will set your career apart from the rest.

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