Senior Compliance Advisor

Community Health Plan of Imperial Valley (CHPIV) is Imperial County's Medi-Cal managed care plan. We are a locally managed public health care plan committed to working with members, providers, and the residents of Imperial County.

As we continue to build something great, we are looking for a Senior Compliance Advisor to stay current on current and emerging regulations related to our business and assist with drafting policies and procedures.

Our next team member will do the following:

• Serve as a direct liaison between CHPIV and regulatory agencies, representing the organization in all compliance-related matters with professionalism and expertise. This includes preparing and delivering well-crafted written communications, engaging in clear oral discussions, and effectively addressing regulatory inquiries, audits, and compliance reviews.
• Develop and implement critical components of the Compliance Program including policies, procedures, training, and monitoring systems, to ensure organizational adherence to regulatory requirements and industry standards.
• Prepare, develop, and manage regulatory submissions to ensure timely and accurate compliance with applicable requirements, including responses to inquiries and filings with regulatory agencies.
• Review, approve and recommend revisions to policies and procedures, member and provider materials, and other key documents to ensure compliance with regulatory requirements. Collaborate with regulators throughout the submission and review process to address feedback and secure approvals.
• Analyze and interpret contractual, state, and federal regulatory requirements. Synthesize complex information into clear, concise summaries that are easily understood by both internal and external stakeholders. This includes presenting requirements in a manner that facilitates decision-making and ensures alignment across all parties involved.
• Review and evaluate implementation plans to ensure they align with regulatory requirements and incorporate any applicable changes. This includes identifying gaps, providing recommendations, and ensuring compliance is maintained throughout the implementation process.
• Lead the management of external state and federal regulatory audits by coordinating preparation activities, managing audit processes, and serving as a primary liaison with regulatory agencies to ensure successful outcomes and address any findings effectively.
• Conduct comprehensive risk assessments to identify potential compliance issues, evaluating impact, and recommending actionable solutions to mitigate risk while ensuring adherence to regulatory requirements.
• Facilitate cross-functional teams including internal business units and/or external entities to correct performance deficiencies.
• Develop comprehensive presentations and materials for the Compliance & Policy Committee and Regulatory Compliance Oversight Committee of the Commission, effectively communicating key compliance updates, trends, data reports, risk assessments, and strategic initiatives.
• Prepare executive summaries that distill complex regulatory information into concise actionable insights, tailored for senior leadership and key stakeholders to support informed decision-making.

You may be right for this job if you have the following:

• Bachelor's degree in Public Health or Health Care Management from an accredited college or university; or equivalent education/experience in a related area. In lieu of a degree, relevant experience may be considered.
• Excellent written and verbal communication skills.
• Knowledge of health care compliance.
• 3-5 years in a Medi-Cal managed care setting or with an IPA.
• Ability to manage multiple priorities and projects and meet deadlines.
• Knowledge of Medi-Cal Managed Care principles and/or government programs.
• Working knowledge of DHCS and Knox-Keene requirements, as well as highly developed analytical and critical thinking skills, to serve as a resource to internal business units and delegates.

Our commitment to you:

• A competitive salary of $80,000-$90,000/ year
• Health, dental, and vision insurance
• Paid time off
• A 401k plan with a generous match
• A chance to make a real difference in the Imperial Valley community

Preference will be given to candidates who are local to Imperial, California, but remote candidates living in California will also be considered.

We are an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.