Regulatory Program Manager

General Description

Under the general direction of the Director of Provider Services, the Provider Services Regulatory Program Manager develops, manages, and improves Provider Services (PS) regulatory and accreditation efforts (e.g. DHCS, DMHC, CMS, and NCQA).  The PS Regulatory Program Manager serves as a subject matter expert, coordinates the submission of deliverables, authors regulatory reports and acts as a liaison across internal departments to enhance Provider Services regulatory compliance.

Duties & Responsibilities

Essential Functions:

• Manage program(s) from initiation through delivery and monitor for continuous improvement. This includes project management of the Provider Services Department’s deliverables for the National Committee for Quality Assurance (NCQA), the Department of Health Care Services (DHCS), the Department of Managed Health Care (DMHC), the Centers for Medicare and Medicaid Services (CMS), the Health Industry Collaboration Effort (HICE) and for Provider Services internal policies and procedures.
• Serve as primary point person and relationship liaison with internal stakeholders for efforts aimed at increasing HPSM’s compliance with provider regulatory requirements. This includes regular collaboration with the  Compliance Department and  Policy Implementation Unit.  
• Develop methods, techniques, and evaluation criterion for obtaining improved regulatory compliance. Project manage the implementation of these improvements, including analyzing project needs, developing project plans, tracking key deliverables.
• Plan, execute, and evaluate program initiatives to improve regulatory performance and operational efficiency, including cross-functional operations.
• Participate cross functionally in business planning to support HPSM compliance, regulatory, and accreditation initiatives.
• Educate and work with the PS department and internal stakeholders to identify innovation opportunities and improve processes and outcomes.
• Function as an organizational subject matter expert on Provider Services regulatory and accreditation requirements.
• Monitor and stay up to date with DHCS, DMHC, CMS, and NCQA requirements pertaining to the provider network and provider credentialing.
• Monitor and ensure timely submission of regulatory and accreditation Corrective Action Plans (CAPs) for the PS Department.
• Contribute to the timeliness and quality of regulatory deliverables both directly and indirectly, i.e., through strong communication and relationship-building with internal and external stakeholders.
• Use sound professional judgement hold stakeholders accountable to shared commitments and appropriately escalate concerns or risks to Supervisor.
• Engage in critical thinking and creative problem solving, adjusting program priorities as needed to meet business needs.
• Continuously align program goals with department and enterprise-wide goals.

Secondary Functions:

• Perform other duties as assigned.

Qualifications   

The following represents the typical way to achieve the necessary skills, knowledge and ability to qualify for this position:

Education and experience are equivalent to:

• Bachelor's degree in healthcare management, business administration, or a related field. Master's degree preferred.
• Three (3) years of experience in public health or healthcare setting, working with provider network, project management or program development and evaluation.
• Experience with Medi-Cal and Medicare programs/members preferred.

Knowledge of:

• Microsoft Office suites, knowledge of Excel, Visio, Powerpoint.
• Process improvement applications and principles.
• Strong knowledge of federal and state healthcare regulations, such as DHCS, DMHC, CMS, MCQMD, NCQA.

Abilities:

• Work cooperatively with others.
• Work as part of a team and support team decisions.
• Adapt to changes in requirements/priorities for daily and specialized tasks.
• Think critically and make informed decisions.
• Perform multiple projects efficiently and with limited oversight, reprioritizing as appropriate.
• Communicate effectively, verbally and in writing.

Skills:

• Excellent project management skills with a track record of successful program implementations.
• Exceptional communication, interpersonal, and negotiation skills.
• Strong organizational skills with ability to prioritize assignments and maintain effective filing systems and meet deadlines.
• Detail-oriented with a focus on accuracy and compliance.