Director Compliance and Regulatory Affairs

13 Nov, 2020

Jobs

Director Compliance and Regulatory Affairs

Sharp HealthCare
San Diego, CA

Responsibilities

Director Compliance and Regulatory Affairs – Sharp Health Plan

Sharp Health Plan is the highest member-rated health plan in California, rated 4.5 out of 5 stars by Medicare, and 4 out of 5 stars by Covered California. The Compliance and Legislative/Regulatory Affairs Department is a key part of Sharp Health Plan’s success, interacting with all other departments in the Plan to ensure compliance with legal and regulatory requirements.

Summary:

The Director Compliance and Regulatory Affairs is responsible for providing effective leadership for Sharp Health Plan in the areas of: commercial and Medicare health plan compliance; federal and state legislative analysis and implementation; regulatory affairs; government relations; privacy; fraud, waste and abuse; government contract compliance; and delegation oversight.

Required Skills and Qualifications:

  • Five (5) years’ experience in position requiring high levels of cooperation, collaboration, and management of staff.
  • Experience leading compliance and regulatory affairs activities.
  • Demonstrated ability to supervise, motivate and coach staff.
  • Experience conducting research, thorough analysis, interpretation of findings and preparing concise, accurate reports.
  • Ability to make strategic and tactical recommendations and implement business plans.
  • High level of integrity; ability to exercise sound judgment and maintain confidentiality.
  • Exceptional diplomacy skills to effectively resolve issues under sometimes stressful circumstances. Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity.
  • Excellent organizational and time management skills.
  • Experience with MS Office and use of computer.
  • Effective interpersonal skills; excellent oral and written communication skills. Professional presentation and public speaking skills. Able to represent Sharp Health Plan effectively internally and externally in dealings with peers and executives, legislators, regulators, consultants, vendors and other parties.

Preferred Skills and Qualifications:

  • Thorough understanding of health services, health care delivery models, health care benefits.
  • Knowledge of state and federal laws and regulations governing health plans including the Knox-Keene Act, ERISA, COBRA, HIPAA, IRS, Public Health Services and other laws governing commercial and Medicare plans.
  • Knowledge of health plan operations.
  • Knowledge of National Association of Insurance Commissioners (NAIC) model rules and other standards. Knowledge of NCQA accreditation standards related to delegation oversight, privacy, and other applicable areas.

Key Responsibilities:

 

  • Completes analyses, establishes policies, programs and goals; and directs the implementation of project/action plans to ensure Sharp Health Plan’s continued compliance with all applicable legislative, regulatory, and contractual requirements in a manner that is consistent with the Plan’s vision, mission and goals.
  • Develops and maintains subject matter expertise on legislative, regulatory and contractual issues affecting commercial and Medicare health plans in California.
  • Establishes communication plans to ensure that Plan staff and leaders understand and comply with legislative, regulatory and contractual requirements. Interacts effectively with various internal and external departments and leaders to provide guidance, information and assistance.
  • Reports on compliance and legislative activities to Plan executives, President/Chief Executive Officer, and Board of Directors. Promotes the satisfaction, development and productivity of department staff. Participates as part of, and in support of, a management team that works collaboratively to ensure the success of Sharp Health Plan’s goals, objectives, and strategic initiatives.

 

Education: 

Undergraduate degree in business, law, health care or related field required.

Master’s degree or Juris Doctor preferred.

 

Licensure/Certification:

Healthcare compliance certification preferred.

Learn more here

 

“Sharp HealthCare is an Equal Opportunity/Affirmative Action Employer.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender, gender identity, transgender status, sexual orientation, protected veteran status, among other things, or status as a qualified individual with disability. Different makes us better”

Job posted: 2020-11-13