Senior Director, Regulatory Compliance (Los Angeles, CA, US, 90017)

L.A. Care Health Plan

Salary Range:  $149,502.00 (Min.) – $201,827.00 (Mid.) – $254,152.00 (Max.)

 

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
 

Job Summary

The Senior Director serves as a senior leader within the Compliance Department, leading compliance efforts across all functions across L.A. Care. The Senior Director manages the following compliance and regulatory functions, such as management of external regulatory audits; including audit readiness and corrective action plans; enterprise-wide compliance monitoring strategies; including administrative and clinical; regulatory agency management; including relationship and complaint management with State and Federal regulatory agencies; regulatory reporting; including design and implementation of quality assurance strategies to ensure reports submitted to regulators are timely, complete, and accurate, and Compliance Committee and Board of Governors compliance reports, meetings and issue escalation. The Senior Director develops and recommends strategic compliance initiatives for L.A. Care, accountable to continuously streamline and improve the overall effectiveness of the department.

 

Directs all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Prioritizes and manages day-to-day operations of the Regulatory Affairs unit (Regulatory Audits, Monitoring, Regulatory Agency Management, Governance, and Regulatory Reporting).  Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.

 

Develops and mentors staff to build a culture of excellence. Responsible for organization structure and sourcing decisions and all people management activities including hiring, training and onboarding, goal setting and performance management.  Builds, manages, motivates and develops teams to monitor and drive consistent quality, efficiency and enhanced solutions that meet the defined high-quality standards.  Prioritizes and manages day to day operations, including supervision of a staff including but not limited to Directors, Senior Managers, Advisors and Specialists, including hiring of staff and evaluation of staff performance.

 

Develops and recommends of strategic plans, Regulatory Affairs, and Compliance Department Operations.  Monitors the day-to-day activities of L.A. Care to further its compliance objectives; ensure compliance with laws, rules, and regulations. Designs, implements, documents, and maintains an enterprise-wide compliance monitoring program and other specialized tools that clearly outline regulatory requirements, detects and corrects non-compliance on an ongoing basis, and drives ongoing remediation. Standardizes, centralizes, and oversees all compliance monitoring activities. 

 

Monitors the performance of the L.A. Care Compliance Program on an ongoing basis, taking appropriate steps to improve its effectiveness. Communicate the importance of compliance to senior management, the compliance committee, and health plan staff. Promote effective lines of communication to and from the Compliance department.  Leads, facilitates or participates in relevant committees and committees as Director determines or as assigned by the Chief Compliance Officer and leadership team. 
 

Duties Continued

Manages all regulatory audits and readiness activities; including mock audits, submission quality assurances, corrective action plan development, approval, and monitoring.  

 

Manages and maintains relations with regulators. This includes reviewing regulatory inquiry trends, notices of non-compliance response, and self-disclosures of non-compliance issues to the regulators. 

 

Develops and maintains productive relationships with all levels of management, staff, and external stakeholders. Conduct periodic enterprise training on prevention, detection, and correction of non-compliance including but not limited to: compliance program effectiveness, regulatory audits, root cause analysis, corrective action plans, and regulatory submissions. 

 

Manages all regulatory reports and internal compliance reports. Designs and implements report quality assurance processes to ensure timely, complete, and accurate submissions. This includes, but is not limited to, periodic live system reviews and data validation tests. Documents and maintains regulatory reporting matrices and report submissions. Communicates regulatory reporting requirements to the organization. Facilitates cross-functional work groups to ensure regulatory reporting processes are developed, documented, and reviewed by all stakeholders. 

 

Ensures organizational compliance with regulatory requirements and effectively communicate to L.A. Care staff, external contacts and regulatory agencies; Builds relationships with regulatory agencies to communicate compliance activities and deliverables.

 

With the Chief Compliance Officer, organize the Internal Compliance Committee (ICC), including developing appropriate agendas, reports, and information requested by the committee and/or Board. 

 

Designs and implements goals and programs that demonstrate strategic thinking focused on achieving operational excellence within the department and with external business partners. 

 

Prepares and presents periodic reports evaluating L.A. Care’s compliance performance to the leadership team, compliance committee, Chief Executive Officer (CEO) and Board of Directors. 

 

Perform other duties as assigned.

Education Required

Bachelor's Degree
In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree

Experience

Required:
At least 8 years of progressive health care compliance and/or audit experience including extensive experience in compliance or auditing in health care or another highly regulated industry.

 

At least 6-8 years of supervisory/management experience.

 

Experience designing, implementing compliance programs, policies and practices; and/or managing health plan/ managed care business operations.  Demonstrate progressive improvement in audit results over time.

 

Strong background and experience in cross-functional/team based approach to problem solving.

Skills

Required:
Excellent interpersonal, verbal, and written communication skills.

 

Knowledge of Word and Excel.

 

Ability to drive strategic vision to accelerate and enhance development of quality control programs for business operations.  Demonstrated ability to brainstorm, develop and implement new compliance/audit initiatives.

 
Demonstrates significant leadership competencies, including employee engagement, strategic thinking, thorough understanding how to use and manage health care data.

 

Demonstrates the ability to mentor and train staff, including improving the capacity of staff to achieve the highest levels of independent auditor performance and business collaboration.

 

Understanding of the vital importance of commitment to excellence and demonstrating a high regard for organizational values.

 

Strong organization and planning skills and be flexible to handle multiple assignments, changing priorities, and meeting.

 

Must be able to present findings to various levels of management, across all organizations.

 

Licenses/Certifications Required

Licenses/Certifications Preferred

Certified HealthCare Compliance (CHC)
Certified Internal Auditor (CIA)

Required Training

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market.  The range is subject to change.

 

L.A. Care offers a wide range of benefits including

  • Paid Time Off (PTO)
  • Tuition Reimbursement
  • Retirement Plans
  • Medical, Dental and Vision
  • Wellness Program
  • Volunteer Time Off (VTO)

 

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