Sr. Regulatory Quality Manager

Blue Shield Of California San Diego , CA 92140

Posted 2 months ago

The Senior Operations Compliance Program Manager, is responsible for managing operational compliance within Medical Care Solutions (MCS) This compliance leader is responsible to understand, develop, and maintain procedures necessary to support audit procedures, satisfy audit control requirements, lead the coordination of internal/external audits, and develop and manage the delivery of timely, accurate and appropriate responses to audit findings and recommendations. This leader will provide oversight and monitoring of the compliance functions within Medical Care Solutions, i.e., risk assessments, Corrective Action Plan (CAP) management, policies and procedures, and audit readiness. This team member reports to the Senior Director of Health Promotion and Education leader is responsible to understand, develop, and maintain procedures necessary to support audit procedures, satisfy audit control requirements, lead the

Specific Responsibilities:

  • Partnering with business drivers to design, develop, deliver, and executing strategy to promote regulatory compliance across MCS

  • Leading regulatory compliance team. Providing ongoing support and development opportunities for all team members from "hire to retire" while ensuring team members have the knowledge, skill, and experience to effectively perform functions.

  • Representing MCS on key committees and project meetings.

  • Providing oversight and leadership.

  • Maintaining, enhancing and reporting on core metrics used to evaluate department regulatory performance.

  • Developing and maintaining relationships with key stakeholders. Scheduling and conducting regular meetings with senior leaders to gain early insights into upcoming product changes and schedules.

  • Implementing a quality assessment strategy and operational metrics; synthesizing training results and metrics to report intelligent data to senior management.

  • Exerting significant decision-making authority, guided by resource availability and functional objectives.

  • Managing budgetary responsibility and certain processes or projects within MCS' department budget.

  • Performing other duties as assigned.

Minimum Education & Experience

  • Current RN or LVN license (preferred)

  • Bachelor's degree or equivalent experience.

  • A minimum of 7 years of related knowledge and experience in health compliance and audits experience is preferred.

  • Knowledge of Blue Shield of California or similar health care organization structure.

  • Previous experience with financial; regulatory/accreditation; internal & external audits is preferred.

  • Demonstrated experience in coordinating, reviewing, preparing, analyzing and identifying issues or risks in audit data.

  • Demonstrated experience in developing and providing appropriate verbal responses and corrective action plans to internal and/or external auditors.

  • Strong negotiation skills and ability to successfully interact with all levels of management.

  • Strong leadership ability while working in a matrixed environment with multiple stakeholders.

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Sr. Regulatory Quality Manager

Blue Shield Of California