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Compliance, Privacy & Regulatory

Putting Integrity Into Practice

Promoting honesty and integrity across our daily actions and interactions, our compliance, privacy, and regulatory professionals provide the guidance and resources to uphold the highest ethical standards.

Regulatory Svcs Sr Manager (RN)

Location: Oakland, CA Job Number: 517439 Date posted: 09/21/2016
Description: Responsible for leading California state regulatory initiatives across all functions statewide, as well as managing relationships & maintaining communications w/stakeholders at all levels, both internally & externally. Accountable for brokering agreements & gaining support for regulatory initiatives from decision makers at all levels. Leads & directs research, planning, implementation, & monitoring, validation, & reporting for a broad portfolio of regulatory systems & initiatives to enable organizational compliance w/ all applicable Federal, state, & local regulations/laws. Advises the organization on all regulatory matters related to the Dept of Managed Health Care (DMHC) & other state regulators. Leverages expertise & relationships to influence health care policy. On an on-going basis, oversees research & interpretation of laws & regulations to establish appropriate compliance standards; may direct the development &/or delivery of training & communications/change Mgmt relative to new standards. May coordinate efforts on behalf of the organization & represent the organization w/ external stakeholders. HPRS is responsible for: Assessment of organizational systems & processes to ensure appropriate Health Plan oversight & survey readiness & to determine gaps for remediation prior to regulatory surveys. Manages & oversees all regulatory filings related to Health Plan's Know-Kleenex license (ex. contracts, benefits, delivery systems, new products). Benefits interpretation to ensure statewide consistency in providing benefits to members & compliance w/benefits provisions in contracts. Processing regulatory complaints in a timely manner & trending, reporting, & analyzing data related to these complaints. Reviews, analyzes, & develops positions & strategies pertaining to legislation, regulations, surveys, Know-Knee filings, or other issues involving our California state regulators. Developing & directing proactive regulatory strategies to support membership growth.

Essential Functions:
  • Personnel Mgmt: Manages the efforts of direct reporting, as well as matrix reporting, positions. Responsible for selecting, developing, & deploying personnel in the most effective manner to meet objectives. Responsible for performance Mgmt, compensation decisions, & providing on-going, regular developmental feedback. Influences performance Mgmt, compensation decisions, & ongoing feedback for individual contributors reporting to direct report Mrgs.
  • Communications, Stakeholder Mgmt, & Negotiation of Agreements: Facilitates communications, manages relationships w/ stakeholders, & negotiates agreement from involved parties for compliance initiatives & programs across functional areas.
  • Issue Mgmt, Response, & Mitigation: Responsible for issue Mgmt, response, & mitigation across functional areas. Proactively identifies risks & issues related to projects & production operations. Anticipates issues through regular communication w/reporting positions & other internal & external parties, mitigating risk or escalating issues for resolution by more senior levels as necessary.
  • Change Mgmt: Responsible for leading change Mgmt efforts across functional areas as well as larger deptal goals or objectives. Identifies & acts upon opportunities to leverage direct reporting team in change Mgmt activities; ensures direct reporting team is engaged in change Mgmt as appropriate.
  • Project Mgmt: Responsible for Mgmt of project plans for objectives or projects across functional areas as well as ensuring project timelines & objectives are met for projects managed by reporting positions.
  • This job description is not all encompassing.

  • Basic Qualifications:
    Experience
  • Minimum three (3) years of management experience.
  • Minimum eight (8) years of progressively-responsible health care administration or regulatory experience.
    Education
  • Bachelor's or clinical degree, OR four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
    License, Certification, Registration
  • N/A

    Additional Requirements:
  • Expert knowledge of regulatory policies, practices and systems.
  • Expert knowledge of regulatory-related practices and standards.
  • Project management skills.
  • Must be able to work in a Labor/Management Partnership environment.

    Preferred Qualifications:
  • Master's or JD degree preferred.
    Primary Location: California,Oakland,1800 Harrison 1800 Harrison Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 8:30 Working Hours End: 5:30 Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Manager with Direct Reports Job Category: Compliance / Privacy / Regulatory Department: Rgulatory Svcs Travel: Yes, 20 % of the Time
    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, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
  • About Compliance, Privacy & Regulatory Careers

    Compliance, Privacy & Regulatory Careers

    We've established a comprehensive, world-class compliance, privacy, and regulatory program, giving you the chance to make a difference in the lives of millions. As a member of this team, you'll engage with internal stakeholders to foster an environment of safety and trust for our members, physicians, and employees alike.

    Helping to establish and maintain an effective compliance program, you'll ensure that we operate according to the highest ethical standards and follow all applicable laws, standards, policies, and procedures. Everything we do — from developing policies and training to protecting privacy and security — reinforces our commitment to our members, regulators, and the communities we serve.

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