Government Program Compliance Medi-Cal Specialist, Senior

Job Description

Job Ttitle: Government Program Compliance Medi-Cal Specialist, Senior

Company: Blue Shield of California


Description: Job Description:Your RoleThe Blue Shield of California Promise Health Plan Compliance team is responsible for the administration and oversight of an effective compliance program. The Government Program Compliance Medi-Cal Specialist, Senior will report to the Senior Manager, Government Programs Compliance Medi-Cal Manager. In this role you will be providing assistance with driving and managing the identification and scoping of impacts across cross-functional business areas due to ongoing, newly enacted, federal and state regulatory requirements. You will collaboratively and advise diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised Medi-Cal requirements.Responsibilities:Your WorkIn this role, you will:

• Documents final compliance solutions, identified risks, and mitigation plans in a controlled document
• Monitors implementation of corrective action plans to ensure on track, risks are identified, mitigation plans are developed; escalates as appropriate
• Summarizes and distributes low to complex federal and state updates to impacted areas
• Conducts federal and state regulatory compliance verification; where compliance gaps are identified, validates quality, timeliness, and progress of corrective action plans
• Conducts more complex audits of Medi-Cal functions
• Manages and maintains Medi-Cal Compliance department activities e.g. development & maintenance of the department audit calendar, CMS, DMHC and DHCS audit calendar, department mailboxes, intranet website, policies and procedures, and other items as needed
• Supports calibration of risk and controls with business units supporting the Medi-Cal line of business
• Develops, prepares, and presents analyses, reports, and recommendations to department management and other stakeholders of federal and state requirements
• Provides day-to-day support guidance to areas that support Medi-Cal products on low to moderately complex inquiries
• Participates in multiple projects or initiatives within and outside of the department
• Other duties as assigned

Qualifications:Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 5 years of prior relevant experience
• Professional certifications & additional degrees a plus
• Knowledge of Medi-Cal regulatory compliance standards and processes preferred

Pay Range: The pay range for this role is $87,230.00 to $130,900.00 for California.Note: Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate’s experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.#LI-LC1About the Team:Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we’re going to do and by acknowledging and correcting where we fall short.
• Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.Two Ways of Working:Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above). Exceptions:Member-facing and approved out-of-state roles remain remote.Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.On-Site: Work from a business unit-approved office an average of four (4) or more days a week.Physical Requirements:Office Environment – roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork – Activity level: Sedentary, frequency most of work day.Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Salary: $87230 – 130900 per year

Location: San Diego, CA

Date: Wed, 18 Dec 2024 23:18:30 GMT


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