Facility: Health Plan

City San Diego

Department

Job Status

Regular

Shift

Day

FTE

1

Shift Start Time

Shift End Time

Driver's License - CA Department of Motor Vehicles; Master's Degree; Bachelor's Degree

Hours :

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$34.795 - $44.897 - $54.999

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do

Leads project implementations for regulatory initiatives. Coordinates and oversees operational processes related to research, documentation and reporting of federal, state and county regulations. Manages the provider attestation process and provider directory production. Streamlines processes and communications among internal and external teams to ensure regulatory filings and reports are completed in a timely manner. Writes and maintains policies and procedures, and manages review and approval processes. Keeps abreast of federal, state and county regulations, policies and procedures, network standards, and performance benchmarks.

Required Qualifications

• 5 Years experience in a managed care or healthcare environment.

• Experience in health plan accreditation and National Committee for Quality Assurance regulatory requirements.

• Driver's License - CA Department of Motor Vehicles -REQUIRED

Preferred Qualifications

• Master's Degree in Healthcare Management, Business, or other degree acceptable with combination of education and managed care experience.

• PMI Project Management Professional (PMP) - Various-Employee provides certificate -PREFERRED

Other Qualification Requirements

• Bachelor's Degree in Healthcare Management, Business, or other related degree; or 3 years of managed care experience in lieu of degree - REQUIRED

• Utilizes reliable transportation and possesses adequate personal insurance coverage. Demonstrates clean driving record in accordance with requirements of the employer DMV pull notice program and Sharp HealthCare Driver Guidelines.

Essential Functions

• Project Management, Coordination and ReportingLeads regulatory projects related to timely access and network filings, medical surveys, accreditation reporting, provider surveys, audits, and provider notifications on a monthly, quarterly or annual basis, as required.Coordinates and oversees project deliverables executed by internal teams and external vendors, as needed, to ensure complete and accurate project submissions.Manages, prioritizes, and completes multiple projects in a timely and accurate manner.Routinely monitors departmental and cross-functional project deadlines and escalates delivery issues, as needed.Creates and maintains project documentation, including implementation plans, calendars, communications plans, status reporting and final reporting. Works closely with internal and external teams to ensure that projects are accurately completed and reported to Compliance department in a timely manner.Creates and maintains project dashboards.Serves as a liaison between the team and the Compliance department in order to stay informed and up to date on latest regulations.Serves as a liaison between the department and other internal departments and external vendors, as needed.Participates in projects, as assigned.

• RegulatoryServes as a subject matter expert on regulatory requirements from federal, state and county regulators, including but not limited to, the Department of Managed Healthcare, Centers for Medicare and Medicaid, National Committee for Quality Assurance, and Covered CA.Maintains requirements database for use by internal and external teams.Writes and updates policies and procedures for all pertinent regulations. Manages internal and Committee reviews and approvals in a timely manner. Ensures policies and procedures are appropriately disseminated and stored.Coordinates and oversees the production of quarterly provider directories for all lines of business. Identifies opportunities for process and member experience improvements.Coordinates and oversees the provider attestation process with an eye to continual process improvement.Routinely attends industry meetings to keep abreast of new regulations or changes. Disseminates internal updates, as needed.Participates in regulatory projects and other duties, as assigned.

• Data ManagementMonitors data collection processes to ensure that the Plan gathers and maintains provider data information as required by regulators.Works closely with technical teams as well as database teams for credentialing and reporting to ensure systems support required provider data for reporting and analysis.Ensures that provider data is accurate, current and accessible in print and online provider directories, when needed by internal and external vendors.Participates in special data management projects, as assigned.Consistently stores project documentation on appropriate shared platforms and provides audit support for regulatory and accreditation surveys through creation, maintenance and appropriate storage of projects, business rules and business process documentation in a timely and compliant manner.

Knowledge, Skills, and Abilities

• Proficient in the MS Office suite, including Word, Excel, PowerPoint, and Access.

• Knowledge of customer relationship management, provider management, customer survey, project management, and credentialing software applications.

• Excellent interpersonal skills, including the ability to communicate both clearly and concisely in a professional manner, both verbally and in writing.

• Possesses strong organizational, critical thinking and analytical abilities in performance of all job duties.

• Ability to develop accurate, well-written and professionally formatted documents, presentations and other materials for internal and external consumption.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class