Health Plan Compliance Director

This rapidly growing Health Plan is actively interviewing for a Director to oversee Compliance Operations for a wide array of product offerings in the San Francisco Bay Area. Join this trusted, community-based healthcare organization, and help redefine how compassionate care is delivered for thousands of members.

Having received top honors and awards for both clinical and administrative operations in San Francisco, the health systems that this plan support are highly regarded in the region. Offering coverage on a full range of services, to a full range of populations, the Compliance Director will help the systems continue to build service offerings while staying within regulatory parameters.

Reporting to the Executive Director of Health Plan Operations, the Compliance Director will play in integral role in keeping the health plan’s operations running smoothly and in accordance with regulatory requirements. This person will work in collaboration with legal experts, clinical administrators, and health plan product development leaders through a wide range of regulatory scenarios and circumstance. 

This Health Plan is looking for a strong, compliance-focused person, with advanced understanding of legal frameworks, healthcare administration models, and internal audit procedures. Working closely with concepts such as the Knox-Keene Act and HIPAA, as well as organizations like The Centers for Medicare & Medicaid Services (CMS) and the California Department of Managed Health Care (DMHC), the Director of Compliance will ensure that the Health Plan and associated organizations are operating in accordance with complex regulatory structures.

Fulfilling the duties of this role will require advanced communication and organization skills, as well as the ability to conduct due diligence investigations. The Director will also oversee general health plan administration compliance for Employer Group Programs, Individual / Family Plans both on and off the exchange, and Medicare Programs. Expert-level knowledge will be required to provide the proper oversight of these product groups. Strong background in the California Health Care Marketplace will be required, as this Director will be the point-of-contact for matters that relate to contractual and statutory obligations of these programs.

Beyond maintaining knowledge of applicable Compliance related matters, another large piece of the Director’s role will be conducting audits of the various system-level processes to detect non-compliance and provide corrective measures for any violations. The Compliance Director will make regular reports to executive leaders for the health plan, the Board of Directors, and regulatory agencies.

The beauty, culture, and weather of the San Francisco Bay Area offers amazing adventures around every corner. Just like the amazing wines and great seafood, once you’ve tasted how good it can be, you’ll never want to leave. The Health Plan Compliance Director will find all these great things, and much more, around every corner. Whether you’re exploring the historic districts around the city, taking in live music, sampling the local vintage at one of the many wineries, eating great seafood, or just kicking back at the beach, you can do it at whatever pace you like. With great schools, close proximity to the San Francisco Bay Area, and a tight knit community, why wouldn’t you want to explore?

The Director of Compliance will serve in a complex and unique role for this community health plan. You’ll find great challenges and support from above and below, and many opportunities to grow your skills. You will enjoy a competitive benefits and compensation package, as well as the knowledge that you’re making a difference in lives every day of the week.