Director Legislative and Regulatory Affairs/Medicare Compliance Officer - Full-time / Part-time

Director Legislative and Regulatory Affairs/Medicare Compliance Officer - 79598QualificationsDirector, Legislative and Regulatory Affairs/Medicare Compliance Officer –Sharp Health PlanThe Legislative and Regulatory Affairs Department of Sharp Health Plan is responsible for ensuring the Plan's compliance with all applicable state and federal rules, regulations, and laws, including CMS, PHS, IRS, HIPAA, ERISA, COBRA, ACA, and the Knox-Keene Act.Sharp Health Plan is San Diego's largest locally based commercial health plan. With a personal approach and a network of medical groups and physicians, Sharp Health Plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.As the top-rated health plan in California*, Sharp Health Plan serves a growing number of companies, large and small, in San Diego and southern Riverside counties.* Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, 2015Summary:Director, Legislative and Regulatory Affairs is responsible for providing effective leadership for Sharp Health Plan in the areas of: federal and State legislative analysis and implementation; regulatory affairs, government relations, compliance, privacy, security, fraud/waste/abuse; government contracts, including but not limited to CalPERS, Covered California and Medicare; and delegation oversight. Serves as Medicare Compliance Officer. Chairs the Plan's Compliance Committee. Develops analyses and recommendations for programs and goals. Implements project/action plans to ensure Sharp Health Plan's continued compliance with all applicable legislative, regulatory, contractual and accreditation requirements in a manner that is consistent with the Plan's vision, mission and goals. Develops and maintains subject matter expertise on contractual, legislative and regulatory issues affecting health plans in California. Establishes communication plans to ensure that Plan staff, leaders and delegated entities understand and comply with contractual, legislative and regulatory requirements. Responsible for ensuring the implementation of such contract requirements, laws and regulations. Directs follow-up assessment of implementations and ongoing activities. Develops organizational policies and procedures in support of compliance. Interacts effectively with various internal and external departments to provide guidance, information and assistance. Efficiently and effectively documents information and activities for use in communication, education and monitoring. Presents reports on compliance activities to the President/Chief Executive Officer and Board of Directors. Promotes the satisfaction, development and productivity of the Regulatory Affairs staff. Participates as part of, and in support of, a management team that works collaboratively to ensure the success of Sharp Health Plan's goals, objectives, and strategic initiatives.Required Skills and Qualifications:* Five (5) years' experience in position requiring high levels of cooperation, collaboration, and management of staff.* Minimum of three (3) years' experience in a leadership role, ideally leading and implementing a comprehensive compliance program.* Experience conducting research, thorough analysis, and interpretation of findings.* Strong leadership and management skills.* Experience leading audits and major program initiatives.* Experience maintaining effective working relationships with regulatory agencies. Thorough understanding of health services, health care delivery models, health care benefits and regulations.* Ability to effectively interpret government contracts to ensure compliance. Demonstrated ability to supervise, motivate and coach staff.Education:* Undergraduate degree in business, law or health care required.* Master's or Juris Doctorate (JD) degree preferred.DescriptionSkills, Knowledge and Abilities:Knowledge of state and federal regulations including California Code of Regulations, especially Title 28, and the Knox-Keene Act. Knowledge of health plan operations. Familiarity with implementation of applicable federal laws including but not limited to ERISA, COBRA, HIPAA, IRS, Public Health Services. Experience with and knowledge of National Association of Insurance Commissioners (NAIC) model rules and other standards. Knowledge of accreditation standards related to delegation oversight, privacy, security and other applicable areas. Ability to analyze and interpret data, and prepare concise, accurate reports. Ability to make strategic and tactical recommendations.High level of integrity; ability to exercise sound judgment and maintain confidentiality. Exceptional diplomacy skills to effectively resolve issues under sometimes stressful circumstances. Readily adaptable to the changing needs of the business; able to manage multiple priorities; tolerance for ambiguity. Excellent organizational and time management skills. Excellent business acumen and writing skills. Experience with electronic mail, word processing, spreadsheets, database programs and Internet research.Effective interpersonal skills; excellent oral and written communication skills. Professional presentation skills including public speaking. Able to represent Sharp Health Plan effectively in dealings with peers and executives (internal and external), legislators, regulators, consultants, vendors and other outside parties who contribute to the success of Sharp Health Plan.Compensation and Benefits:The position provides a very competitive compensation, including opportunity to participate in a management bonus incentive program along with a generous benefit package.About Sharp HealthCare ~Sharp HealthCare is a not-for-profit integrated regional health care delivery system based in San Diego, California. Sharp includes four acute care hospitals, three specialty hospitals, two affiliated medical groups, a health plan, plus a full spectrum of other facilities and services. Serving a population of approximately 3 million in San Diego County, Sharp has more than 17,000 employees and 2,600 affiliated physicians on medical staffs, and operates 1,867 beds. The Sharp Experience is our unique, system wide commitment to transforming the health care experience in San Diego by becoming the best place to work, practice medicine and receive care.Sharp HealthCare Awards and RecognitionsSharp HealthCare BenefitsSince 2001, our team has been on an exciting journey to transform the health care experience. We are passionate about providing health care the way it should be.With exceptional skill. With advanced technology. And, especially, with kindness and empathy toward our patients and their loved ones. It's going beyond caring for people to caring about people. This is the extraordinary level of care we call The Sharp Experience.Encouraging everyone to find their passion and purpose is at the heart of The Sharp Experience. We are focused on providing an innovative and caring environment where employees are valued for the role they play in helping Sharp achieve its vision to be the best place to work, practice medicine and receive care. Become a part of our team and find out what it means to do what you love.Physical Requirements:Incumbent spends approximately 4-6 hours per day sitting at desk, entering data on computer terminal and talking on telephone. Incumbent spends approximately 1-2 hours per day walking between Plan departments. Ability to hear and speak clearly over the telephone. Ability to meet frequent deadlines and tight schedules. Ability to travel between Sharp Health Plan, other Sharp HealthCare facilities, and community resources. Must provide own transportation. Business travel to Sacramento, other locations within California, and out of state may also be required.Additional Physical Requirements may be discussed during the interview"Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class."Keywords: Director, Legislative and Regulatory Affairs, Health Plans, Medicare Compliance, California Code of Regulations, Title 28, Knox-Keene Act, Healthcare compliance jobs, Health plan jobs, NAIC, Sharp Health Plan jobs, Sharp HealthCare jobs, Covered California jobs, Executive jobs, HealthCare Executive jobs