Regulatory Affairs Manager
Company: Partnership HealthPlan of California
Posted on: September 21, 2022
Overview: Responsible for leading and managing employees in the
assigned areas of responsibility within
the Regulatory Affairs Unit. Manages and maintains relationships
with state and federal
regulators. Responsible for managing the plan's HIPAA and Fraud,
Waste, and Abuse (FWA)
program to ensure plan is within compliance. Develops reports and
present information to all
levels of PHC leadership. Oversees the day to day operations
related to the investigation, case
management and reporting of potential privacy and FWA incidents to
ensure the timely
submission of all regulatory reporting requirements are met. Also
responsible for managing the
validation and submission processes related to enterprise wide
regulatory reporting requirements. Responsibilities:
Provides daily direction to direct reports and is responsible for
management, including timecards, performance discussions,
mentorship, and development plans.
Assigns workload and monitors performance, evaluates priority level
and makes changes as necessary.
Meets with direct reports to review project and program status on a
routine basis, provides feedback and guidance where
Promotes team development and works with direct reports to
establish development plans.
Coaches and mentors Regulatory Affairs Unit staff.
Identifies, monitors and evaluates unit's operations to ensure
optimal efficiency and effectiveness.
Manages and maintains relationship through communications with DHCS
and DMHC as one of HealthPlan's primary contacts as well as
communicates routinely with DHCS Privacy Officer, DHCS Program
Integrity Unit, DHCS Audit & Investigation Unit, California's
Department of Justice and the Office of Civil Rights.
Develops tools and standard processes to ensure regulatory
reporting requirements and other ad hoc deliverables such as
inquires, surveys or request are submitted timely.
Works closely with other departments on responding to inquiries,
surveys and other ad hoc requests from regulatory agencies.
Works collaboratively with department subject matter experts (SME)
to implement new regulatory reporting requirements or templates and
assist in troubleshooting regulatory reporting issues.
Responsible for managing duties that ensure the accuracy,
completeness and truthfulness of enterprise wide regulatory
reporting including data, information and documentation submitted
to regulatory agencies.
Manages the tracking, monitoring and communication of regulatory
communications to impacted areas and Senior Management
Chairs meetings related to compliance including the Physical
Technical, and Administrative Safeguard Sub-Committee and Fraud,
Waste and Abuse Sub-Committee as well as those related to
regulatory requirements or regulatory reporting changes.
Works with PHC's Privacy Officer to develop, implement and maintain
the organizations privacy policies, procedures, and guidelines in
compliance with federal and state laws.
Acts as designee for Compliance Office and Privacy Officer to
independently investigate and act on compliance, privacy and FWA
related activities including internal investigations, hotlines
calls, or other issues reported and implementing corrective action
plans as appropriate.
Maintains a modified caseload in the area of assignment including
escalated or sensitive cases involving employees in which is
responsible for conducting investigations including interviewing
employees, collecting and maintaining documentation, and providing
recommendations to Compliance and/or Privacy Officers as
Prepares routine privacy risk assessment and presents
recommendations to PHC's Privacy Officer and other Senior
Manages the tracking and trending of privacy and FWA cases to
identify systemic issues, problem providers and/or members
Collaborates with satellite and regional offices to standardize
plan wide privacy practices.
Develops and implements departmental goals annually designed to
increase performance and efficiency of unit.
Develops or oversees the development of compliance trainings,
New hire compliance training and Compliance Primers,
Annual compliance training - HIPAA, FWA, and Code of Conduct
Annual Compliance Plan training
Targeted departments - as applicable on topics identified through
tracking and trending of privacy or FWA incidents as well upon
request by departments for refresher trainings or other topics
Other mandatory compliance trainings
Manages the maintenance of the Regulatory Affairs and Compliance
Monthly reporting of privacy, FWA, and compliance issues
Reports statistics to PTAS Sub-Committee, FWA Sub-Committee and
Delegation Oversight responsibilities including auditing and
monitoring of compliance with privacy, FWA and other regulatory
reporting requirements. SECONDARY DUTIES AND RESPONSIBILITIES
Researches complex regulatory related inquires, provides accurate
and timely responses utilizing all applicable State and Federal
Qualifications: Education and Experience Bachelor's Degree in
Business, Communication, Healthcare
Administration, Business Administration, or related field; a
minimum of 2-3 years of experience in the health care field,
experience preferred, with knowledge of Medi-Cal, Knox-Keene,
Medicare regulations; or an equivalent combination of education
experience. Minimum two (2) years of experience with conducting
privacy and/or fraud investigations preferred. Special Skills,
Licenses and Certifications HCCA Certified in Healthcare Compliance
(CHC) or Certified in
Healthcare Privacy Compliance (CHPC) preferred. Solid collaboration
and facilitation skills required. Valid California driver's license
and proof of current automobile insurance compliant with PHC policy
are required to operate a vehicle and travel for company business
Performance Based Competencies Demonstrated leadership
skills/experience. Ability to work within an
interdisciplinary structure and function independently in a
environment while managing multiple priorities and deadlines.
Excellent oral and written communication skills. Excellent
organizational skills required. Diplomacy and tact in handling
sensitive information regarding personnel affairs as required.
Ability to interact with executives and vendors effectively,
handling all assignments with efficiency. Excellent judgment. Work
Environment And Physical Demands More than 50% of work time is
spent using a desktop computer. When necessary, the ability to
lift, carry, or move manuals and reports, weighing up to 25 lbs.
Ability to travel as needed. Must be able to work in a fast paced
environment and maintain courtesy and composure when dealing with
internal and external customers. Ability to function effectively
with frequent interruptions and direction from multiple team
members. All HealthPlan employees are expected to: Provide the
highest possible level of service to clients;
Promote teamwork and cooperative effort among employees;
Maintain safe practices; and
Abide by the HealthPlan's policies and procedures, as they may from
time to time be
updated. IMPORTANT DISCLAIMER NOTICE The job duties, elements,
responsibilities, skills, functions, experience, educational
factors and the requirements and conditions listed in this job
description are representative only and not exhaustive of the tasks
that an employee may be required to perform. The employer reserves
the right to revise this job description at any time and to require
employees to perform other tasks as circumstances or conditions of
its business, competitive considerations, or work environment
Keywords: Partnership HealthPlan of California, Fairfield , Regulatory Affairs Manager, Executive , Fairfield, California
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