Clin Compliance Consult Sr-102742

Mô tả công việc

Prefer position may either be located in our Woodland Hills, CA office or work from a home office in So. CA, but will consider any of our locations. Responsible for supporting, clinical regulatory compliance for a state, delegated entities, or enterprise wide for designated lines of business through project leadership, technical oversight and risk identification and mitigation. Primary duties may include, but are not limited to: Serves as point of contact, coordinating and collaborating with regulatory bodies and business partners to ensure compliance with regulatory, accrediting and Health Plan quality of care and service requirements. Assists with the interpretation of applicable laws and regulations. Develops tools that assist in determining exposure to regulatory and/or accreditation risks. Identifies opportunities to manage and mitigate those risks. Works with business management areas to develop metrics for monitoring program objectives and policies and procedures that support compliance with regulatory and accreditation standards. Compiles information related to quality improvement and compliance monitoring activities for internal use and external audits and maintains relevant records. Monitors corrective action plans relating to regulatory or accreditation compliance. Makes recommendations to business unit partners for improvements or remediation to risk management, regulatory, and accreditation compliance programs. Monitors development and use of metrics for regulatory compliance. Monitors business unit initiatives relating to the development and implementation of a risk management program for utilization management activities. Collaborates with enterprise quality team, enterprise care management, and other clinical teams on regulatory initiatives. Creates audit tools, reports, standardized policies and procedures, and manuals. Facilitates implementation of survey or regulatory recommendations. Recommends new processes.