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NEOGOV · 2 weeks ago

Regulatory and Contract Compliance Specialist (Contracts Specialist Sr)

Orange, CA

Full-time

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. They are seeking a Regulatory and Contract Compliance Specialist to support the development, implementation, and ongoing monitoring of the Contracting department's regulatory compliance activities and ensure adherence to policies and procedures.

GovTechHuman ResourcesInformation TechnologySoftware

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 managementProject managementData analyticsManaged care contractingProvider relationsAnalytical skillsCommunication skillsTeam collaborationProblem-solving

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

Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds

Work independently and exercise sound judgment

Communicate clearly and concisely, both orally and in writing

Work a flexible schedule; available to participate in evening and weekend events

Organize, be analytical, problem-solve and possess project management skills

Work in a fast-paced environment and in an efficient manner

Manage multiple projects and identify opportunities for internal and external collaboration

Motivate and lead multi-program teams and external committees/coalitions

Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment

Ability to visually read information from computer screens, forms and other printed materials and information

Ability to speak (enunciate) clearly in conversation and general communication

Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions

Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting

Lifting and moving objects, patients and/or equipment 10 to 25 pounds