Regional Director - Managed Care Compliance

Regional Director - Managed Care ComplianceJoin to apply for the Regional Director - Managed Care Compliance role at Torrance MemorialRegional Director - Managed Care Compliance1 day ago Be among the first 25 applicantsJoin to apply for the Regional Director - Managed Care Compliance role at Torrance MemorialEstablishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations.Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers.Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff.Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements.Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies.Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators.Manage Compliance Department’s administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars.Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc.Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance.Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.DescriptionPRIMARY DUTIES AND RESPONSIBILITIES:Establishes and coordinates an effective, comprehensive Managed Care Compliance Program in accordance with federal, state and health plan requirements for all enterprise managed care operations. Oversees all aspects of the Managed Care Compliance Program, and works to enhance existing compliance programming, developing new policies and procedures and monitoring existing policies and procedures as appropriate to ensure full compliance with applicable laws, regulations, accrediting organizations and contractual obligations.Oversees Policy and Procedure Management which includes ensuring that compliance policies and procedures within managed care operations are up to date. Ensures providers receive and understand these policies and provide evidence to health plan that the policies were distributed and received by providers.Provides leadership, training and support to all direct reports, and provides daily supervision of Compliance Department staff.Working in collaboration with business unit owners, ensures policies and procedures related to delegated operations are compliant with regulatory, accrediting body and contractual requirements.Establishes/implements monitoring programs to ensure compliance and keeps records of all compliance activities in accordance with retention of records policies.Serves as the primary compliance contact for external stakeholders, including the health plans, accreditation bodies and regulators.Manage Compliance Department’s administrative duties, including but not limited to organizing and maintaining complete department files, records, documentation, project plans and calendars.Prepares comprehensive, timely executive-level reports with regular cadence to keep leadership aware of audit status, compliance risks, etc.Fully and timely report to all appropriate leaders and staff of upcoming audits audit results, corrective actions so thet the enterprise is fully prepared for optimal audit performance.Identifies potential areas of compliance vulnerability and risk and prepares annual Compliance Risk Assessment that identifies these risks. Works with operational leaders and SMEs to developmitigation plans to address as appropriate.Department-specific ResponsibilitiesCOMPLIANCE: Serves as Chair of the Managed Care Compliance Committee. Prepares agenda and arranges for the regular and ad hoc meetings of the Managed Care Compliance CommitteeSupervisory/Management ResponsibilitiesManages Compliance Department staff to include overseeing the work of others, assigning or allocating work to team, and ensuring work is completed according to deadlines and quality standards.Teamwork/Customer Relations ResponsibilitiesCollaborates to make decisions to achieve desired outcomesEstablishes effective working relationships with cross-functional teams, external stakeholders.JOB QUALIFICATIONS:Education:Bachelor’s degree from an accredited four-year institution requiredMaster’s degree in healthcare administration, Law, Public Administration, or Business Administration strongly preferred.Work Experience:Minimum 7 years work experience in regulatory affairs and/or complianceMinimum 5 years work experience in California managed care regulatory affairs and/or complianceMinimum 5 years work experience in providing guidance to senior level leadersLicenses and CertificationsCertification In Healthcare Compliance - PreferredSalary Range: $125,000 - $185,000,000/yrSeniority levelSeniority levelDirectorEmployment typeEmployment typeFull-timeJob functionJob functionHealth Care ProviderIndustriesHospitals and Health CareReferrals increase your chances of interviewing at Torrance Memorial by 2xGet notified about new Director of Managed Care jobs in Torrance, CA.Los Angeles, CA $160,000.00-$180,000.00 2 weeks agoManhattan Beach, CA $160,000.00-$180,000.00 2 weeks agoLos Angeles, CA $160,000.00-$180,000.00 23 hours agoManhattan Beach, CA $160,000.00-$180,000.00 23 hours agoGlendale, CA $150,000.00-$220,000.00 3 weeks agoExecutive Director, Healthcare Performance Analytics - #1 Hospital in CAVice President, PRIME (Bill Review and Managed Care)Torrance, CA $200,000.00-$240,000.00 5 days agoDirector Managed Care - Managed Care Contracting - Full Time 8 Hour Days (Exempt) (Non-Union)Director-Quality and Performance ImprovementManaged Care and Payor Relations Director, Managed Care - #1 Hospital in CALos Angeles, CA $116,426.00-$174,639.00 2 weeks agoExecutive Director, Healthcare Markets Initiative, USC Schaeffer CenterDirector of Reimbursement - Fullerton - $110-120kSenior Director, Access & Reimbursement- WestHuntington Park, CA $282,407.28-$338,888.72 1 week agoAssistant Director Medi-Cal Managed Care ProgramsLos Angeles, CA $80,000.00-$85,000.00 2 weeks agoDirector, Provider Network Development (Health Plan)Associate Director, Network Contracting & ServicesLos Angeles, CA $105,000.00-$115,000.00 1 month agoLos Angeles, CA $104,394.49-$160,000.00 1 month agoDirector of Business Development - HealthcareHuntington Beach, CA $55,000.00-$68,000.00 1 month agoBCBA Assistant Clinical Director – Buena ParkBuena Park, CA $90,000.00-$95,000.00 1 week agoSenior Director of Market Access, Payor Strategy, and ContractingSenior Director, Head of US Trade, Pricing and ContractingSanta Monica, CA $237,575.00-$307,450.00 2 days agoNational Account Director - Immunology - WestSeal Beach, CA $100,000.00-$110,000.00 3 days agoSeal Beach, CA $100,000.00-$110,000.00 4 days agoLos Angeles, CA $68,640.00-$80,000.00 1 month agoWe’re unlocking community knowledge in a new way. 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Created: 2025-10-06