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CalOptima · 2 weeks ago

Regulatory and Contract Compliance Specialist (Contracts Specialist Sr)

Orange, CA

Full-time, Contract

Hybrid

Mid, Senior Level

$72K/yr - $115K/yr

4+ years exp

CalOptima is a mission-driven community-based organization that serves member health with excellence and dignity. The Regulatory and Contract Compliance Specialist will support the development and monitoring of regulatory compliance activities, ensuring adherence to policies and procedures while collaborating with various stakeholders.

GovernmentHealth CareNon Profit

Comp. & Benefits

Responsibilities

Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability

Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department

Interacts with staff and leadership to analyze, identify and make recommendations to the Contracting department's policies, procedures and processes pursuant to obligations imposed by CMS, DHCS or other regulatory agencies

Collaborates with the RAC department to implement regulatory requirements, update policies and procedures, and coordinate department activities as needed

Tracks and reports on department activities to demonstrate compliance with regulatory updates and company policies

Leads and monitors multiple small to medium sized projects under tight timelines simultaneously

Collaborates closely with Contracting leadership on multiple department projects; keeps leadership informed on progress, issues and status of new contracts, policies and regulatory requirements

Prepares summaries and detailed reports regarding contracted provider network(s) and assigned projects as needed

Completes other projects and duties as assigned

Qualification

Regulatory complianceContract managementData analyticsManaged care contractingProject managementCommunication skillsProblem-solvingTeam collaborationOrganizational skillsLeadershipFlexibility

Required

Associate degree PLUS 4 years of experience in the health care field interacting with members, physicians, medical groups, health plans or regulatory agencies, overseeing administrative updates, data analytics or provider relations activities required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying