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Regulatory Svcs Director

Location: Pasadena, California;

Job ID : 3650700


Responsible for leading California state regulatory initiatives across all functions statewide, as well as managing relationships & maintaining communications w/ stakeholders at all levels, both internally & externally. Accountable for brokering agreements & gaining support for regulatory initiatives from decision makers at all levels. Leads & directs research, planning, implementation, & monitoring, validation, & reporting for a broad portfolio of regulatory systems & initiatives to enable organizational compliance w/all applicable Federal, state, & local regulations/laws. Advises the organization on all regulatory matters related to the Department of Managed Health Care (DMHC) & other state regulators. Leverages expertise & relationships to influence health care policy. On an on-going basis, oversees research & interpretation of laws & regulations to establish appropriate compliance standards; may direct the development &/or delivery of training & communications/change Mgmt relative to new standards. May coordinate efforts on behalf of the organization & represent the organization w/ external stakeholders. HPRS is responsible for: Assessment of organizational systems & processes to ensure appropriate Health Plan oversight & survey readiness & to determine gaps for remediation prior to regulatory surveys. Manages & oversees all regulatory filings related to Health Plan's Know-Kleenex license (ex: contracts, benefits, delivery systems, new products). Benefits interpretation to ensure statewide consistency in providing benefits to members & compliance w/ benefits provisions in contracts. Processing regulatory complaints in a timely manner & trending, reporting, & analyzing data related to these complaints. Reviews, analyzes, & develops positions & strategies pertaining to legislation, regulations, surveys, Know-Knee filings, or other issues involving our California state regulators. Developing & directing proactive regulatory strategies to support membership growth.

Essential Functions:
- Personnel Mgmt: Manages the efforts of direct reporting, as well as matrix reporting, positions. Responsible for selecting, developing, & deploying personnel in the most effective manner to meet objectives. Responsible for performance Mgmt, compensation decisions, & providing on-going, regular developmental feedback. Influences performance Mgmt, compensation decisions, & ongoing feedback for individual contributors reporting to direct report Mrgs, possibly through more than one layer of subordinate Mgmt.
- Communications, Stakeholder Mgmt, & Negotiation of Agreement: Facilitates communications, manages relationships w/stakeholders, & garners support & agreement from involved parties for compliance initiatives & programs for functional areas across the enterprise.
- Issue Mgmt, Response, & Mitigation: Responsible for issue Mgmt, response, & mitigation for functional areas across the enterprise. Proactively identifies risks & issues related to projects & production operations. Anticipates & addresses issues through regular communication w/reporting positions & other internal & external parties at all levels, mitigating risk or, in the most severe cases, escalating issues for resolution by more senior levels as necessary.
- Change Mgmt: Responsible for leading change Mgmt efforts for functional areas across the enterprise. Identifies & acts upon opportunities to leverage direct reporting team in change Mgmt activities; ensures direct reporting team is engaged in change Mgmt as appropriate.
- This job description is not all encompassing.
Qualifications: Basic Qualifications:
- Minimum five (5) years of management experience.
- Minimum ten (10) years of progressively-responsible health care administration or regulatory experience.
- Bachelor's or clinical degree, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A

Additional Requirements:
- Expert knowledge of regulatory policies, practices and systems.
- Expert knowledge of regulatory-related practices and standards.
- Project management skills.
- Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:
- Master's or JD degree preferred.

Primary Location:California,Pasadena,Regional Offices-Walnut 393 E. Walnut St.

Scheduled Hours (1-40):40


Working Days:Mon-Fri


Job Type:Standard

Employee Status:Regular

Employee Group:Salaried, Non-Union, Exempt

Job Level:Director/Senior Director

Job:Compliance / Privacy / Regulatory

Public Department Name:Health Plan Regulatory Services

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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