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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 Consultant V

Location: Pasadena, CA Job Number: 684851 Date posted: 07/11/2018
Description: HPRS is responsible for leading California state regulatory initiatives across all functions statewide, as well as managing relationships and maintaining communications with stakeholders at all levels, both internally and externally.
Researches, plans, implements, and monitors a broad portfolio of regulatory systems and initiatives to enable organizational compliance with all applicable Federal, state, and local regulations/laws. Advises the organization on all regulatory matters related to the Department of Managed Health Care (DMHC) and other state regulators. On an on-going basis, researches and interprets regulations and laws to establish standards, and may develop and/or deliver training and communications/change management relative to new standards. Assesses organizational systems (both physical and process or data related) to determine gaps in compliance and determine opportunities for remediation. Advises the organization on all compliance matters. May investigate violations of compliance policy, laws, regulations, etc. or conduct on-going monitoring and reporting to ensure remediation. May be responsible for project management relative to new compliance initiatives, products, or annual processes.
HPRS is responsible for:
  • Assessment of organizational systems and processes to ensure appropriate Health Plan oversight and survey readiness and determine gaps for remediation prior to regulatory surveys.
  • All regulatory filings related to Health Plan's Knox-Keene license (ex. contracts, benefits, delivery systems, new products).
  • Benefits interpretation to ensure statewide consistency in providing benefits to members and compliance with benefits provisions in contracts.


    Essential Responsibilities:
    HPRS is reponsible for:
  • Processing regulatory complaints in a timely manner and trending, reporting, and analyzing data related to these complaints.
  • May be responsible for project management relative to new regulations, legislation, surveys, new products, or other issues involving state regulators.
  • Developing and directing proactive regulatory strategies to support membership growth.
    HPREO is responsible for:
    Evaluating, interpreting, identifying and documenting business impacts and overseeing the implementation of the work as a result of Federal Commercial and Medicaid rules, regulations and laws across all functions and regions. This includes managing relationships and maintaining communications with stakeholders at all levels and management and/or oversight of ongoing operations required for participation on public exchanges.
    HPREO is responsible for:
  • Analysis of Federal commercial and Medicaid rules, regulations, laws and guidance to understand the business impacts.
  • Ensure ownership for implementation.
  • Serve as the FFM Exchange lead by overseeing end to end administrative operations and responding to questions and issues from the regulator.
  • Monitor all product and rate filings.
  • Lead the QHP recertification Community of Practice and oversee successful QHP recertification in all jurisdictions.
  • Responsible for project oversight relative to implementation of new Federal Commercial and Medicaid regulations, rules or laws.
  • Manages, creates, and maintains client relationships with management at all levels of the organization. An understanding of end to end business operations and business functions and how regulations impact business operations.
  • May independently manage complex business processes required for participation on public exchanges and communicate with internal stakeholders and regulators.
  • Fosters comprehensive regulatory management through a series of activities to comply with all applicable regulations and statutes. Activities include:
  • Planning: leading the identification of regulatory accountabilities; identification of internal and external resources; development of regulatory work plans; establishing and/or leading regulatory-related /work groups; and managing external agency relations,
  • Implementing: leading the identification of regulatory requirements and directing related analyses; creation and revision of regulatory standards, policies, and procedures; leading the monitoring of regulatory adherence; and directing reporting on regulatory efforts and programs, and
  • Validating: reviewing regulatory programs and content.
  • Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Communicates required changes, and leverages existing workgroups/etc. to facilitate required changes. May engage external regulatory and legislative bodies on developing regulations and laws, providing input and representing Kaiser Permanente's interests.

  • Oversee the development of operational policies and procedures that are more complex involving multiple regions and departments.



  • Basic Qualifications:
    Experience
  • Minimum twelve (12) years of health care experience or other applicable experience-health care operations, audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience.
  • Years spent in law school that resulted in a law degree may count as applicable job experience; JD will be counted in lieu of 3 years of experience.
    Education
  • Bachelor's 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:
  • Years spent in law school resulting in a law degree may count as applicable job experience.
  • Expert knowledge of health care operations, regulatory policies, practices and systems and regional operational differences.
  • Develops advanced regulatory concepts.
  • Expert knowledge of health care industry practices and standards.
  • Ability to draft and revise documents including analyses, and reports.
  • Project management and/or consulting skills.


    Preferred Qualifications:
  • Master's degree preferred.

    Primary Location: California,Pasadena,Regional Offices-Walnut 393 E. Walnut St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon - Fri Working Hours Start: 8:30 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Compliance / Privacy / Regulatory Department: Health Plan Regulatory Services Travel: Yes, 20 % 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 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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