Job Description

Job Location Main Office - Santa Barbara, CA 93110 Position Type Full Time Salary Range $120,970.00 - $181,455.00 Salary/year Job Category Regulatory Compliance

Salary Range: $120,970 - $181,455

While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.

The Medi-Cal Compliance Manager plays a key role within the Compliance Division, reporting directly to the Regulatory Compliance Director. This role is responsible for providing leadership and guidance of CenCal Health’s compliance program, ensuring adherence to regulatory requirements, industry standards, and organizational policies for Medicare, Medi-Cal, and Knox Keene. The Medi-Cal Compliance Manager possesses a deep knowledge of Medi-Cal regulations, strong leadership skills, and a commitment to promoting a culture of compliance throughout the organization.

Duties & Responsibilities

• Co-develop, implement, integrate, and manage the compliance program for all CenCal Health lines of business, ensuring it aligns with regulatory requirements and industry best practices. Ensure integration of the Medicare compliance program with CenCal Health’s existing compliance framework.

• Provide guidance and leadership to cross-functional teams involved in Medicare, Medi-Cal, and Knox Keene compliance activities, including but not limited to Legal, Operations, Clinical, and Quality Assurance teams.

• Collaborate with the Regulatory Compliance Department to maintain compliance with CMS, DHCS, and DMHC requirements, including CenCal Health’s Knox Keene license and contractual obligations with regulatory agencies.

• Collaborate with the Audits, Monitoring, and Oversight (AMO) Department within the Compliance Division to conduct regular assessments and audits of Medi-Cal processes, systems, and documentation to identify compliance risks and areas for improvement.

• Collaborate with the Audits, Monitoring, and Oversight (AMO) Department and internal stakeholders to address compliance issues, develop corrective action plans, and monitor progress towards resolution.

• Responsible for daily monitoring of regulatory requests, required DHCS reporting, DMHC filings, and other required regulatory submissions.

• Responsible for ensuring that all required CMS, DHCS, DMHC and other regulatory reports, including any required attestations, are submitted within required timeframes.

• Co-develop for Medicare and D-SNP and integrate with the current process for communicating regulatory information in a clear and concise manner and implementing solutions to support internal and external operational and compliance activities.

• Consult on investigations for any incoming compliance complaints of potential non-compliance. Collaborate with Security, Privacy and Fraud Prevention Office (SPF) regarding potential Fraud, Waste and Abuse, as needed.

• Partner with SPF to ensure that the DHHS OIG and Government Services Administration (“GSA”) exclusion lists have been checked with respect to all employees, governing body members, and FDRs monthly and coordinating any resulting personnel issues with the sponsor’s Human Resources, Security, Legal or other departments as appropriate.

• Keep abreast of changes in Medicare, Medi-Cal, and Knox Keene regulations, guidance, and enforcement priorities.

• Co-develop and implement training programs and educational materials on Medicare, Medi-Cal, and Knox Keene compliance topics to employees at all levels of the organization. New training programs should integrate with the organization’s training program.

• Participate in compliance-related committees, working groups, and initiatives to promote a culture of integrity, ethics, and compliance.

• Supervises Compliance staff, with duties including but not limited to overseeing job performance, prioritizing and assigning work-related tasks, and training new staff, as necessary.

Qualifications

Knowledge/Skills/Abilities

• In-depth knowledge of Medi-Cal and Medicare regulations, including but not limited to Medicare Advantage (Part C), Prescription Drug Plans (Part D), and Medicare fee-for-service (Parts A and B), as well as and Knox Keene requirements.
• In-depth knowledge of health care compliance programs and how to implement and maintain the OIG’s seven elements of a compliance program.
• Strong leadership and management skills, with the ability to influence and collaborate effectively across functional areas and levels of the organization.
• Excellent communication and interpersonal skills, with the ability to convey complex regulatory concepts clearly and concisely to diverse audiences.
• Analytical mindset with the ability to identify compliance risks, develop mitigation strategies, and monitor effectiveness of controls.
• Commitment to upholding ethical standards, integrity, and professionalism in all aspects of compliance-related activities.

Education and Experience

• Bachelor's degree in Healthcare Administration, Business Administration, Legal Studies, or a related field or an equivalent combination of education and experience.
• Advanced degree (e.g., JD, MPH, MBA) preferred.
• Minimum of 5 years of experience in healthcare compliance, with a focus on Medi-Cal compliance and regulations.
• Certification in Healthcare Compliance (CHC), Certified in Healthcare Privacy and Compliance (CHPC), or similar credentials are strongly preferred.

Competencies

• Management Administration Skills: Manages and/or facilitates employees, budgets and equipment assigned to them, while helping employees maintain a clear picture of their roles and responsibilities to achieve organizational objectives. Helps to develop employee performance by delegating responsibilities and providing accurate feedback and assessments on a timely basis
• Leadership Skills: Able to assume a role of formal or informal authority as necessary; advocate new ideas, even when risk is involved; delegate responsibility and empower associates to make decisions; capable of providing constructive feedback to others; able to receive constructive feedback from others; makes personal commitment to mentor and grow others
• Strategic Thinking: Formulates objectives and priorities, and implements plans consistent with the long-term interest of the organization in a global environment, capitalizes on opportunities and manages risks
• Communication Skills-Oral, Listening & Written: Communicates both verbally & in writing in such a manner that it is easy to understand and interpret what and why information is being communicated. Listens attentively without interrupting and/or being distracted by other things

• Collaboration & Teamwork Utilizes communication techniques & methods that generate trust, collaboration, open two-way communication and a supportive work environment. Develops and generates team momentum, enthusiasm, and camaraderie to obtain maximum team performance. Values diverse talents of team members and works to include various points of view in decision-making
• Human Capital Management: Builds and manages workforce based on organizational goals, budget considerations, and staffing needs. Ensures employees are appropriately recruited, selected, appraised, and rewarded; takes action to address performance problems. Manages a multi-sector workforce and a variety of work situations
• Conflict Management: Encourages creative tension and differences of opinions. Anticipates and takes steps to prevent counter-productive confrontations. Manages and resolves conflicts and disagreements in a constructive manner
• Decisiveness: The ability to make difficult decisions in a timely manner.
• Walk the Talk Do what you say you are going to do. Be accountable for your actions
• World Class Mindset: Behaves in an honest, fair, and ethical manner. Shows consistency in words and actions. Models’ high standards of ethics. Punctual, exhibits professional email etiquette. Adhere to company and department standards. Commitment to excellence.

Essential Functions

• Physical requirements needed to perform the essential functions of this job, with or without accommodation:
  • Mobility Requirements: ability to operate a keyboard and sit for long periods; reach, bend, crawl, stoop, lift up to ten (10) lbs.
  • Visual Requirements: ability to read close-up and do close-up work
  • Dexterity Requirements: ability to perform repetitive motion (keyboard); writing (notetaking)
  • Hearing/Talking Requirements: ability to hear normal speech, hear and talk on the telephone
  • Emotional/Psychological Requirements: ability to deal with public contact, in person and Normal office environment. Must be able to sit and work at a computer for long periods of time
• Must be able to travel to the office as necessary and attend meetings during and after regular work hours
• Possess a current, valid driver’s license with a clean driving record
• Regular attendance is essential to perform this job