Director, Regulatory Affairs and Compliance (Medi-Cal)

01 Nov, 2021


Director, Regulatory Affairs and Compliance (Medi-Cal)

Orange, CA

Job Summary

The Director of Regulatory Affairs & Compliance (Medi-Cal) directs CalOptima’s relationships with regulatory agencies. The incumbent will manage professional staff in ensuring the management of CalOptima’s contractual, statutory, and regulatory obligations with federal and state regulatory agencies. The incumbent will ensure CalOptima’s strategic goals and objectives are communicated with regulatory agencies and that CalOptima’s strong reputation with regulatory agencies is maintained.

Position Responsibilities:

  • Directs and oversees CalOptima’s activities, including regulatory audits, with state regulatory agencies, including but not limited to, the California Department of Health Care Services (DHCS) and the California Department of Managed Health Care (DMHC).
  • Directs and oversees CalOptima’s internal policies and procedures to ensure compliance with statutory, regulatory, and contractual requirements. Also, oversees the internal and regulatory approval of policies and procedures to meet operational needs.
  • Directs and oversees the tracking, monitoring, impact assessment, and communication of all regulatory communications to impacted business areas and senior management.
  • Directs and oversees the submission of regulatory reporting requirements and other types of required filings for CalOptima’s Medi-Cal program.
  • Directs and oversees the issuance and management of corrective action plans for issues of non-compliance related to CalOptima’s Medi-Cal program.
  • Directs the Regulatory Affairs & Compliance department, including the supervision of professional and administrative personnel.
  • Supports the Executive Director of Compliance and other Executives in communications and strategic alliances with regulators by preparing for all major meetings, hearings, events, and by creating opportunities for CalOptima to present on behalf of the program.
  • Advises CalOptima’s executive management on policy direction and position.
  • Builds and continuously improves the Regulatory Affairs & Compliance department as the one-stop’ shop for regulatory information by:
    • Improving upon current tools used to disseminate regulatory updates and communications from key regulators.
    • Providing ongoing training on policy writing and the use of key departmental tools.
    • Affirmatively soliciting input from the key functional areas and the executive team to improve the department’s responsiveness to organizational needs.
  • Represents CalOptima at various meetings and functions.
  • Other projects and duties as assigned.

Possesses the Ability to:

  • Establish and maintain effective working relationships with CalOptima leadership and staff.
  • Communicate clearly and concisely, both verbally and in writing.
  • Have strong interpersonal skills.
  • Motivate, encourage the development of staff, make sound recommendations, and lead staff.
  • Be a self-starter who brings drive and creativity to goal achievement.
  • Translate complex concepts into clear messages.
  • Travel both locally and regionally (to Sacramento and Washington D.C.).
  • Make presentations and respond to questions in a public setting with ease and clarity.
  • Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Visio, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Experience & Education:

  • Bachelor’s degree in Healthcare Administration, Business Administration, Public Administration, Clinical Area, Law, or a relevant field or the equivalent combination of education and/or experience in a related field required.
  • 7 years of regulatory experience in government or healthcare in a public or government affairs role required.
  • 5 years of management level experience, including direct supervision of staff, in Managed Care or health plans and oversight of a Medi-Cal program required.
  • Executive experience which includes working relationships with senior members of management and significant experience making presentations to organizational boards, committees, and regulatory agencies required.
  • Experience interacting with state and federal regulators required.
  • Experience with interpretation and application of state and federal program requirements, regulations and laws required.

Preferred Qualifications:

  • Master’s degree in Healthcare Administration, Business Administration, Public Administration, Clinical Area, or Law preferred.
  • Strong regulatory relationships with DHCS, and/or the DMHC preferred.

Knowledge of:

  • Statutes, regulations, and sub-regulatory guidance related to Medi-Cal managed care.
  • Managed Care operations and issues that affect the organization.
  • Pertinent federal and state laws related to healthcare.
  • Policy implications and impact of policy decisions on the organization.
  • Managing staff and coordinating the work of interactive groups.

CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.

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Job posted: 2021-11-01