Regulatory Liaison job vacancy in CenCal Health, (Santa Barbara, CA 93110)

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Job Details
Company Name :
CenCal Health
Company Location :
Santa Barbara, CA 93110
Job Position :
Regulatory Liaison
Job Category :
Jobs in California

Job Description :
Job Summary (General Overview, reporting to, work environment) To support CenCal Health in meeting regulatory requirements through the preparation and filing of reports and submission of other information required by state agencies through audits and requests. Coordinates implementation of audit corrective action plans, All Plan Letters, and other regulatory requirements. This position reports to the Department Director or designate.
Duties and Responsibilities Acts as a liaison between Internal Departments, Compliance staff and Health Services leadership. Evaluates regulatory and contractual requirements as relates to the provider network Health Services. including but not limited to: network adequacy, timely access, data, and quality As the subject matter expert, leads Health Services staff in gathering and analyzing data as needed to demonstrate regulatory and contractual compliance. Assists in the preparation and timely filing of recurring and ad-hoc reports required to be submitted to the state Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MRMIB), Centers of Medicare and Medicaid Services and other agencies
Coordinates implementation of audit corrective action plans, All Plan Letters, and track, implement and coordinate other regulatory requirements. Coordinates the internal information gathering and preparation as may be required during audits or other requests from regulatory agencies Prepares responses to comment letters and audit findings from regulatory agencies within the timeframes dictated by those agencies Assists in the development and maintenance of policies and procedures consistent with regulatory and state contract requirements and current industry standards Oversee policy updates, tracking, and version control. Assists in the implementation of Health Services audit processes to ensure compliance with federal and state statutes and regulations Other related projects and duties as may be required

Education and Experience Minimum of three (3) years experience in managed care setting Must have a minimum experience of 1 year in compliance activities (e.g. writing policies, updating policies, participating in audits or preparing audit deliverables). Must have experience researching, compiling and organizing information from various sources Experience working with regulatory agencies desirable; knowledge of Medi-Cal, MediCare and Knox-Keene requirements preferred Knowledge of and proficiency in the use of Microsoft Word, Excel, Visio and PowerPoint software Comfortable with learning to use new computer systems as necessary
Required Skills/Knowledge/Abilities Solid understanding of principles of Medi-Cal, MediCare and managed care Understanding of federal and state regulatory bodies and processes Understanding of CenCal Healths operations and processes a plus Ability to effectively prioritize multiple tasks and deadlines Ability to effectively, clearly and independently document, summarize and resolve complex issues Ability to analyze and interpret regulatory and contractual requirements Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position Ability to develop and organize electronic and paper filing systems Ability to communicate accurately and effectively, both orally and in writing Ability to establish and maintain effective and cooperative working relationships with management and staff Ability to work under pressure to accurately complete tasks within established deadlines
Competencies Continuous Learning: Spends time and energy to learn new approaches, tools, and methodologies to stay abreast and move ahead in position/field. Computer Skills: Ability to quickly assimilate and use computer operating systems and applications. Advanced skills with computer programs including MS Excel, Word, PowerPoint and Outlook. Interpersonal /Customer Services Skills: Treats others with courtesy, sensitivity and respect. Considers and responds appropriately to the needs and feelings of different people in different situations. Nurtures internal and external customers to develop confidence, trust and long-term relationships/partnerships. Initiative & Motivation: Displays strong personal initiative and motivation to achieve desired performance results. Takes on tasks and assumes responsibility without being asked to do so. Takes charge in the absence of detailed instructions and/or plans. Results Orientation: The ability to focus on the desired result of ones own or ones units work, setting challenging goals, focusing effort on the goals, and meeting or exceeding them. Thoroughness: Ensuring that ones own and others work and information are complete and accurate; carefully preparing for meetings and presentations; following up with others to ensure that agreements and commitments have been fulfilled. Flexibility: Displays ability to quickly adapt to changing requirements, special assignments and workload re-prioritization. Openness to different and new ways of doing things; willingness to modify ones preferred way of doing things. 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 highly ethical manner. Shows consistency in words and actions. Punctual, exhibits professional email etiquette. Adhere to company and department standards. Commitment to excellence.
Essential Functions (Consider sitting, standing, travel, working at computer for long periods of time, lifting etc.) Physical requirements needed to perform the essential functions of this job, with or without accommodation: o Mobility Requirements: ability to operate a keyboard and sit for long periods; stand, sit, reach, bend, crawl, stoop, lift up to ten (10) lbs. o Visual Requirements: ability to read close-up and do close-up work o Dexterity Requirements: ability to perform repetitive motion (keyboard); writing (note-taking) o Hearing/Talking Requirements: ability to hear normal speech, hear and talk on the telephone o 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 outside the office and attend meetings during and after regular work hours Regular attendance is essential to perform this job Possess a current, valid drivers license with a clean driving record

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