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  • Health Plan Director of Compliance and Government Regulations

    Martinez, California United States Contra Costa County, CA Full Time $132,689.16 - $161,284.56 Annually Dec 20, 2024
    Contra Costa County Human Resources Department Employer:

    Contra Costa County, CA

    The County of Contra Costa, California was incorporated in 1850 as one of the original 27 counties of the State of California, with the City of Martinez as the County Seat.  Contra Costa County is home to more than one million residents. Comprised of 19 cities and many established communities in the unincorporated area, it is the ninth most populous county in the state. The most notable landmark in the county is Mount Diablo, rising 3,849 feet at the northern end of the Diablo Range. It is the centerpiece of Mt. Diablo State Park, one of many recreation areas residents and visitors can enjoy. The East Bay Regional Park District is comprised of more than 100,000 acres within 65 parks, including more than 1,200 miles of trails. Our Mission: Contra Costa County is dedicated to providing public services which improve the quality of life of our residents and the economic viability of our businesses. Our Vision: Contra Costa County is recognized as a world-class service organization where innovation and partnerships merge to enable our residents to enjoy a safe, healthy and prosperous life. Our Values: Contra Costa County serves people, businesses and communities. Our organization and each one of our employees value: Clients and communities Accountability Partnerships Fiscal prudence Quality Services Organizational excellence   Featured Image by My Nguyen- Miller Knox Regional Shoreline (2019)

    Apply Now View job Employer Profile

    Job Description

    The Position


    ****Re-Announcement****

    Why Join Contra Costa County Health Services?
    The Contra Costa Health Services Department is recruiting for one (1) qualified candidate interested in the Health Plan Director of Compliance and Government Regulations position assigned to the Contra Costa Health Plan (CCHP) located in Martinez, CA.

    The Health Plan Director of Compliance and Government Regulations will be responsible for providing compliance direction, developing strategies, developing action plans, advising the application of statutes and regulations that are relevant to CCHP’s business activities, and acting as the primary leader for all compliance matters.

    Here are several noteworthy accomplishments that CCHP gained recognition over the last 50 years:
    • California County Sponsored Medi-Cal Contract
    • Sponsored plan in the nation to have Medicare
    • Knox Keene Licensed Federally Qualified HMO
    • Only Medi-Cal Managed Care Plan integrated into a health delivery system in the county
    • Medi-Cal Managed Care Plan with 24/7 Advice Nurse Operations
    • Staying power in the community - 50 years of serving low-income populations in Contra Costa County
    • Quality accreditation by the National Committee on Quality Assurance (commendable in several quality areas)
    • National Affiliation of Community Health Plan selected CCHP for the Childhood Obesity Program

    We are looking for someone who:
    • Understands the complexities of health plans and Managed Care
    • Is knowledgeable in administering rigid government contracts
    • Can interpret California Health & Safety Codes
    • Is well organized and can track sanctions and legal processes
    • Understands quality assurance, internal auditing, and oversight of corrective action plans, and can lead a team of clinical and non-clinical leaders

    What you will typically be responsible for:
    • Enforcing compliance rules for Centers for Medicare & Medicaid Services (CMS), Department of Health Care Services (DHCS), and other regulatory agencies
    • Serving as a representative for all departments providing accurate guidance for regulatory compliance issues
    • Overseeing and managing the Fraud Waste and Abuse program, as well as connecting with the health delivery system
    • Uploading documentation to regulator portals for reporting in a timely manner
    • Working with the Medical Directors on Member Appeals and State inquiries to ensure Contra CCHP’s operations are meeting state laws

    A few reasons why you might love this job:
    • We offer fantastic and competitive health benefits, paid vacation/sick/personal/admin time, and a great retirement plan!
    • You will have the opportunity to lead and design new health care policies to improve the quality of life for vulnerable populations
    • You will learn a new delivery system that impacts 14 million lives state-wide
    • Contra Costa County offers a hybrid schedule (in office / work from home), based upon the manager’s discretion

    A few challenges you might face in this job:
    • CCHP is a highly regulated environment
    • There will be complaints, grievances, and appeals filed by Health Plan members that must be addressed in a timely manner
    • California Advancing and Innovating Medi-Cal (CalAIM) is a major transformation of Medi-Cal with a 5-year aggressive plan
    • There will be constant changes in our managed-care environment

    Competencies Required:
    • Building & Maintaining Relationships : Establishing rapport and maintaining mutually productive relationships
    • Delivering Results : Meeting organizational goals and customer expectations and making decisions that produce high-quality results by applying technical knowledge, analyzing problems, and calculating risks
    • Displaying Ownership and Accountability : Holding self and others accountable for measurable high-quality, timely, and cost-effective results
    • Leadership : Guiding and encouraging others to accomplish a common goal
    • Leading Cross-Divisional Collaboration : Demonstrating cooperation and teamwork while working within and across divisions and teams
    • Legal & Regulatory Navigation : Understanding, interpreting, and ensuring compliance with laws and regulations
    • Managing Organizational Complexity : Maneuvering through complex political situations and functions within the organization
    • Professional Integrity & Ethics : Displaying honesty, adherence to principles, and personal accountability
    • Self-Management : Showing personal organization, self-discipline, and dependability
    • Strategic Thinking & Perspective : Evaluating immediate actions in context of achieving long range objective


    To read the complete job description, please click here . The eligible list established from this recruitment may be used to fill future openings for up to 6 months.

    Minimum Qualifications

    Experience: Two (2) years of full-time (or its equivalent experience) in a health care industry with responsibility for regulatory compliance and anti-fraud activities.

    Education: Possession of a bachelor's degree from an accredited college or university with a major in business administration or a closely related field.

    Desirable Qualifications:
    • Candidates with a Master’s Degree or higher and who have experience in regulatory affairs are strongly encouraged to apply.
    • Experience in a public sector environment.
    • Experience in a Managed Care setting.


    Selection Process

    Application Filing and Evaluation: Applications will be evaluated to determine which candidates will move forward in the next phase of the recruitment process.

    Remote Oral Interview: Candidates that meet the minimum qualifications will be invited to participate in a remote oral interview. The assessment will measure candidates' competencies as they relate to the job. In the assessment, candidates must achieve an average passing score of 70% or higher on each of the competencies and an overall passing score of 70% or higher. These may include, but are not limited to: Delivering Results, Legal & Regulatory Navigation, Managing Organizational Complexity, Professional Integrity & Ethics, and Strategic Thinking & Perspective . (Weighted 100%)
    The assessments may be administered remotely using a computer or mobile device such as a tablet. You will need access to a reliable internet connection to take the assessment.

    TENTATIVE EXAM DATES

    Remote Oral Interview: XXXXX

    For recruitment questions, please contact Health Services Personnel, Recruitment Team at Exams@cchealth.org . For any technical issues, please contact the Government Jobs’ applicant support team for assistance at +1 855-524-5627.

    The Human Resources Department may change the examination steps noted above in accordance with the Personnel Management Regulations and accepted selection practices.

    CONVICTION HISTORY

    After you receive a conditional job offer, you will be fingerprinted, and your fingerprints will be sent to the California Department of Justice (DOJ) and the Federal Bureau of Investigation (FBI). The resulting report of your conviction history (if any) will be used to determine whether the nature of your conviction conflicts with the specific duties and responsibilities of the job for which you have received a conditional job offer. If a conflict exists, you will be asked to present any evidence of rehabilitation that may mitigate the conflict, except when federal or state regulations bar employment in specific circumstances. Having a conviction history does not automatically preclude you from a job with Contra Costa County. If you accept a conditional job offer, the Human Resources Department will contact you to schedule a fingerprinting appointment.

    DISASTER SERVICE WORKER

    All Contra Costa County employees are designated Disaster Service Workers through state and local law. Employment with the County requires the affirmation of a loyalty oath to this effect. Employees are required to complete all Disaster Service Worker-related training as assigned, and to return to work as ordered in the event of an emergency.

    EQUAL EMPLOYMENT OPPORTUNITY

    It is the policy of Contra Costa County to consider all applicants for employment without regard to race, color, religion, sex, national origin, ethnicity, age, disability, sexual orientation, gender, gender identity, gender expression, marital status, ancestry, medical condition, genetic information, military or veteran status, or other protected category under the law.

    To find more information on Benefits offered by Contra Costa County, please go to https://www.contracosta.ca.gov/1343/Employee-Benefits

    Closing Date/Time: 1/9/2025 11:59 PM Pacific
    Apply Now View job Employer Profile

    Please mention you found this employment opportunity on the CareersInGovernment.com job board.

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