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Years of Experience
Date Last Verified
ProfileCommercial Compliance Manager The candidate will develop analyses and recommendations for programs and goals. Will implement 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. Develop and maintains subject matter expertise on contractual, legislative and regulatory issues affecting health plans in California. Establish 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. Direct 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. Present reports on compliance activities to the President/Chief Executive Officer and Board of Directors. Promote the satisfaction, development and productivity of the Regulatory Affairs staff. Participate 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. Masters / JD degree is preferred. Should undergraduate degree in business, law or health care. Should have 5+ years of experience in position requiring high levels of cooperation, collaboration, and management of staff. Experience in a leadership role, ideally leading and implementing a comprehensive compliance program is needed. Experience with and knowledge of National Association of Insurance Commissioners (NAIC) model rules and other standard is advantageous. Experience conducting research, thorough analysis, and interpretation of finding is essential. Knowledge of state and federal regulations including California Code of Regulations, especially Title 28, and the Knox-Keene Act is advantageous. Knowledge of health plan operation is advantageous. Familiarity with implementation of applicable federal laws including but not limited to ERISA, COBRA, HIPAA, IRS, Public Health Services is essential.