Compliance Specialist - Mso - Managed Care Operations

JOB SUMMARY:

Reporting to the Director of Claims and Systems Administration and functioning as an independent, the Compliance Specialist's primary function is to ensure the Managed Care business unit is meeting compliance with rules, policies, and procedures of DHCS and DMHC, Federal and State law regulations as they pertain to both Medi-Cal and Commercial lines of business. Interprets and ascertains regulatory changes, legislative efforts, and /or industry trends specific to Managed Care operations and keeps Management Team informed of relative changes. The incumbent will serve as the liaison for external and internal audits for managed care delegated functions, consultation and analytic support as well as, tracking Corrective Action Plans and outcomes. This position is also instrumental in facilitating compliance program activities to be in alignment with Rady Integrated Delivery System (IDS) department strategies, goals and objectives and will work collaboratively with members across Rady and CPMG organizations.

MINIMUM QUALIFICATIONS:

Bachelor’s Degree

5 years of experience

5 years of Managed Care experience

PREFERRED QUALIFICATIONS:

The Compliance Specialist is a service oriented individual with a high degree of integrity and professionalism, handling and assembling confidential and sensitive information

Excellent verbal and written communication, solid mathematical skills, detail orientation, as well as, professional interpersonal skills are essential

Strong knowledge of relevant regulations for managed care operations for both Commercial and Medi-Cal lines of business and experience managing healthcare service plan delegation audits

Self-motivated with the ability to independently create, plan, organize and coordinate related activities to the position

Comfortable interacting with executive level positions both internally and externally

The expected hiring range for this position is $30.96 to $42.57

Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity.