Compliance Manager

Description

JOB SUMMARY

The Compliance Manager serves as the primary operational lead responsible for the day-to-day execution and sustainability of the organization’s compliance program across a healthcare MSO and its affiliated entities in California. This role provides second-line oversight of operational audit programs and ensures ongoing compliance with federal and state healthcare regulations.

Acting as the program’s “assurance” lead, the Compliance Manager is responsible for validating that key operational functions—including Medical Management, Credentialing and Claims—are meeting delegated audit and compliance obligations. This role is critical to maintaining program defensibility, mitigating regulatory risk, and enabling the Director of Regulatory Compliance to focus on enterprise strategy.

The Compliance Manager partners cross-functionally with Legal, Regulatory, Privacy, Quality, and Operations to implement compliance initiatives, manage risk, and support audit readiness.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: Bachelor’s degree in Healthcare Administration, Public Health, Business Administration, or a related field.

Preferred: Master’s degree (MSN, MBA, MHA, MPH) or equivalent advanced education.

Experience 

Minimum: At least eight years of healthcare compliance or regulatory experience. Experience in California healthcare environment.

Preferred: Experience in California’s managed care, medical group, IPA, MSO, or health plan environment.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

Professional certification (e.g., CHC – Certified in Healthcare Compliance) preferred.

Skills, Knowledge & Abilities

· Strong knowledge of California and federal healthcare regulations (e.g., NCQA, Knox-Keene/DMHC, HIPAA, Covered California, CMS)

· Ability to interpret regulations and health plan contracts and translate into operational processes 

· Excellent interpersonal skills, ability to develop relationships with stakeholders; a solutions-oriented collaborator 

· Strong analytical, organizational, and problem-solving skills 

· Experience managing audits, investigations, and compliance workflows 

· Ability to manage multiple priorities and deadlines in a fast-paced environment 

· Ability to work independently and provide detail oriented, precise and meticulously reviewed work product

· Effective communication and cross-functional collaboration skills

· Exhibits professional maturity, confidence and competence in daily business interactions

· High level of integrity, discretion, and professional judgment

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical demands described here are represented by those that must be met by an employee to successfully perform the essential functions of this job. Primarily a sedentary, hybrid role involving computer-based work with occasional travel. Requires strong analytical thinking, attention to detail, and the ability to manage complex regulatory issues under deadlines in a fast-paced   environment. Includes frequent interaction with internal teams and external stakeholders, as well as occasional lifting or moving equipment up to 15 pounds.