Medicaid Compliance OfficerPrimary Location: San Diego, CA
Additional Locations: CA-San Diego Apply
Our Medicaid Compliance team has an opening for Sr Compliance Lead. This is an expert level position that applies specialized expertise in compliance, business, analytical and communication skills to support, manage and help develop compliance strategies, programs and processes to promote compliant and ethical behavior, meet regulatory obligations and prevent, detect and mitigate compliance risks.
- Leads, implements, and maintains an effective Compliance program, including, but not limited to, risk assessment, auditing and monitoring, maintaining effective compliance policies and procedures, and effective communication and training.
- Prepares highly complex regulatory reports, filings and follow-ups, and manages highly complex regulatory review and audit activities.
- Independently manages multiple highly complex regulatory interactions including drafting regulatory correspondence, responding to regulatory inquiries and negotiating resolution of regulatory matters requiring a sophisticated understanding of business processes and regulatory requirements.
- Leads highly complex compliance business process reviews, corrective actions and other projects involving internal and external constituents.
- Independently develops strategy, processes, forms and related materials to meet the most complex regulatory and legal requirements.
- Builds and maintains positive, productive relationships with internal and external constituents at the most senior and regulatory organizational levels, and is able to remove significant barriers, drive decision-making and influence ethical and compliant outcomes at all organizational levels necessary to accomplish goals.
- Applies expert industry and compliance knowledge to lead highly complex matters involving established compliance system and operations, including processes for implementation of laws and regulations, support of the Company’s Privacy Office on privacy issues, monitoring of compliance issues, and handling of the most complex complaints.
- Independently identifies and assesses the most complex compliance issues and risks, engages appropriate enterprise resources, supports internal and external constituents in the development and monitoring of effective corrective action, error prevention and risk mitigation plans and related activities and communications.
- This may include the development of new or updated policies and processes.
- Appropriately informs and escalates matters to senior management.
- Independently collects facts and utilizes strong analytical capabilities to recommend appropriate actions on the most complex matters and effectively communicates status and results in a concise and timely manner.
- Responds to the most complex requests for information within area of responsibility from internal and external constituents.
- Acts as resource and subject matter expert for colleagues and effectively guides teams to accomplish complex goals.
- Identifies shifting strategic priorities and leads the implementation of both tactical and strategic solutions.
- Other components relevant to the specific role.
- 8+ years’ experience in a regulatory compliance position in healthcare, insurance or financial services or work experience in a relevant business area.
- Experience leading complex projects.
- Bachelor’s degree and advanced degree desired or certification or equivalent experience.
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