Torrance Memorial
Regional Director - Managed Care Compliance
Torrance Memorial, Torrance, California, United States, 90504
Regional Director - Managed Care Compliance
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Regional Director - Managed Care Compliance
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Torrance Memorial Regional Director - Managed Care Compliance
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Regional Director - Managed Care Compliance
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Torrance Memorial Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations. Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers. Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff. Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements. Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies. Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators. Manage Compliance Department’s administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars. Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc. Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance. Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.
Description
PRIMARY DUTIES AND RESPONSIBILITIES:
Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations. Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers. Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff. Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements. Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies. Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators. Manage Compliance Department’s administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars. Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc. Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance. Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.
Department-specific Responsibilities
COMPLIANCE: Serves as Chair of the Managed Care Compliance Committee. Prepares agenda and arranges for the regular and
ad hoc
meetings of the Managed Care Compliance Committee
Supervisory/Management Responsibilities
Manages Compliance Department staff to include overseeing the work of others, assigning or allocating work to team, and ensuring work is completed according to deadlines and quality standards.
Teamwork/Customer Relations Responsibilities
Collaborates to make decisions to achieve desired outcomes
Establishes effective working relationships with cross-functional teams, external stakeholders.
JOB QUALIFICATIONS:
Education:
Bachelor’s degree from an accredited four-year institution required
Master’s degree in healthcare administration, Law, Public Administration, or Business Administration strongly preferred.
Work Experience:
Minimum
7 years work experience in regulatory affairs and/or compliance
Minimum 5 years work experience in California managed care regulatory affairs and/or compliance
Minimum 5 years work experience in providing guidance to senior level leaders
Licenses and Certifications
Certification In Healthcare Compliance - Preferred
Salary Range: $125,000 - $185,000,000/yr
Seniority level
Seniority level Director Employment type
Employment type Full-time Job function
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Join to apply for the
Regional Director - Managed Care Compliance
role at
Torrance Memorial Regional Director - Managed Care Compliance
1 day ago Be among the first 25 applicants Join to apply for the
Regional Director - Managed Care Compliance
role at
Torrance Memorial Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations. Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers. Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff. Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements. Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies. Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators. Manage Compliance Department’s administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars. Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc. Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance. Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.
Description
PRIMARY DUTIES AND RESPONSIBILITIES:
Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations. Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers. Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff. Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements. Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies. Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators. Manage Compliance Department’s administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars. Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc. Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance. Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.
Department-specific Responsibilities
COMPLIANCE: Serves as Chair of the Managed Care Compliance Committee. Prepares agenda and arranges for the regular and
ad hoc
meetings of the Managed Care Compliance Committee
Supervisory/Management Responsibilities
Manages Compliance Department staff to include overseeing the work of others, assigning or allocating work to team, and ensuring work is completed according to deadlines and quality standards.
Teamwork/Customer Relations Responsibilities
Collaborates to make decisions to achieve desired outcomes
Establishes effective working relationships with cross-functional teams, external stakeholders.
JOB QUALIFICATIONS:
Education:
Bachelor’s degree from an accredited four-year institution required
Master’s degree in healthcare administration, Law, Public Administration, or Business Administration strongly preferred.
Work Experience:
Minimum
7 years work experience in regulatory affairs and/or compliance
Minimum 5 years work experience in California managed care regulatory affairs and/or compliance
Minimum 5 years work experience in providing guidance to senior level leaders
Licenses and Certifications
Certification In Healthcare Compliance - Preferred
Salary Range: $125,000 - $185,000,000/yr
Seniority level
Seniority level Director Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Torrance Memorial by 2x Get notified about new Director of Managed Care jobs in
Torrance, CA . Los Angeles, CA $160,000.00-$180,000.00 2 weeks ago Manhattan Beach, CA $160,000.00-$180,000.00 2 weeks ago Los Angeles, CA $160,000.00-$180,000.00 23 hours ago Manhattan Beach, CA $160,000.00-$180,000.00 23 hours ago Glendale, CA $150,000.00-$220,000.00 3 weeks ago Executive Director, Healthcare Performance Analytics - #1 Hospital in CA
Vice President, PRIME (Bill Review and Managed Care)
Torrance, CA $200,000.00-$240,000.00 5 days ago Director Managed Care - Managed Care Contracting - Full Time 8 Hour Days (Exempt) (Non-Union)
Director-Quality and Performance Improvement
Managed Care and Payor Relations Director, Managed Care - #1 Hospital in CA
Los Angeles, CA $116,426.00-$174,639.00 2 weeks ago Executive Director, Healthcare Markets Initiative, USC Schaeffer Center
Director of Reimbursement - Fullerton - $110-120k
Senior Director, Access & Reimbursement- West
Huntington Park, CA $282,407.28-$338,888.72 1 week ago Assistant Director Medi-Cal Managed Care Programs
Los Angeles, CA $80,000.00-$85,000.00 2 weeks ago Director, Provider Network Development (Health Plan)
Associate Director, Network Contracting & Services
Los Angeles, CA $105,000.00-$115,000.00 1 month ago Los Angeles, CA $104,394.49-$160,000.00 1 month ago Director of Business Development - Healthcare
Huntington Beach, CA $55,000.00-$68,000.00 1 month ago BCBA Assistant Clinical Director – Buena Park
Buena Park, CA $90,000.00-$95,000.00 1 week ago Senior Director of Market Access, Payor Strategy, and Contracting
Senior Director, Head of US Trade, Pricing and Contracting
Santa Monica, CA $237,575.00-$307,450.00 2 days ago National Account Director - Immunology - West
Seal Beach, CA $100,000.00-$110,000.00 3 days ago Seal Beach, CA $100,000.00-$110,000.00 4 days ago Los Angeles, CA $68,640.00-$80,000.00 1 month ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr