Health Plan Compliance and Regulatory Affairs Manager

A quickly growing Health Plan Organization in the San Francisco Bay area is actively interviewing for a Manager to oversee Compliance and Regulatory Affairs. Join this outstanding community-based health organization, and help promote quality care and access throughout the region.

Serving San Francisco and the Bay Area for over 30 years, this community health plan keeps quality patient care and affordable access at the core of its mission. As part of an integrated health system, which has been recognized by The Joint Commission and by the community for high-quality care, this health plan is a very important element of that mission. This Manager will serve in a role that is integral to the Health Plan, ensuring that Regulatory Compliance is maintained and the various metrics are closely tracked.

Reporting to the Chief Compliance and Operations Officer (CCOO), and working closely with the Health Plan Director of Clinical Services, the Manager of Regulatory Compliance will serve in a role that is crucial to the strategic operations of the organization. Though this person won’t have any direct reports, the Quality Manager will occasionally pull Quality Assurance and Quality Reporting staff from other departments to help collect data, prepare reports, and share results throughout the organization.

The Regulatory Affairs Manager will play an expansive role throughout the Health Plan Organization, collaborating with specialists, analysts, and professionals from many functional departments. The Manager’s primary duty will be to develop and execute Auditing and Monitoring processes for the Compliance Department. This person will track billing practice, documentation operations, and daily functions against governmental regulations, local and national laws, and organizational policy. Success in this role will require a great communication skills and the ability to work across functional departments, as well as a sense of problem solving. Many of the systems used to collect, measure, and evaluate data will be created in a way that’s applicable across the organization. 

Thought focusing on the operations that support Regulatory Affairs and Compliance, the Manager will get the opportunity to lead Quality Improvement (QI) initiatives as well. This person will engage the Health Plan’s Member Services department to survey and collect data on customer satisfaction, and work with Medicare HOS (Health Outcomes Survey) and CAHPS (Consumer Assessment of Health Plans Study) to develop applicable surveys and additional data collection techniques. These are year round projects that will require strong organizational skills to implement and maintain accreditation.

Known the world around to have something for everyone, the San Francisco Bay Area has been an attractive place to live for hundreds of years. Whether you’re an outdoors person, a city dweller, or something in between, the many quaint regions of the Bay Area will satisfy. The Manager of Health Plan Regulatory Affairs will find gorgeous coastline, nature trails, and parkland all around one of California’s most beautiful cities. With Silicon Valley and San Jose a short distance to the south, Stanford, UC Berkeley, and some of California’s best primary schools, the Bay Area is a great place for the UR Utilization Review Nurse to build a community and continue learning. Connected by Bay Area Rapid Transit and one of the nation’s best networks of buses and light-rails, you’ll find that it’s easy to get where ever you’re going.

The Health Plan Compliance Manager will play a direct role in realizing the organization’s growth and development plans. You’ll get the opportunity to work with a wide array internal and external partners, driving the health system’s mission with every decision. For the dedication and hard work that this role will require, the Manager will receive a generous benefits package, a competitive compensation, and the job security that comes with a growing and healthy organization.