Manager, Compliance Systems & Operations

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Director of Compliance & Risk Management, the Manager, Compliance Systems & Operations is responsible for overseeing, managing, and administering strategic enterprise-wide compliance initiatives, Compliance Program, and compliance technical initiatives. The role ensures the work aligns with IEHP strategic regulatory and compliance initiatives and is conducted and executed effectively. The Manager, Compliance Systems & Operations is responsible for Compliance Program operational processes including development, implementation and management of special projects, initiatives, and programs while ensuring the facilitation of program effectiveness that is consistent with regulatory and contractual requirements. The incumbent is responsible for the daily activities and functions of the Compliance Systems & Operations Unit, including the management, evaluation, mentoring, and coaching of direct reports. In this capacity, the Manager, Compliance Systems & Operations is responsible for coordinating, implementing, monitoring, and measuring the progress of all projects, compliance program operations, and measuring the performance/outcomes of such efforts on a routine basis. The Manager, Compliance Systems & Operations partners with leadership to lead and develop the buildout of a strategic and comprehensive compliance program to ensure consistent, continuously effective practices to identify and mitigate compliance risk.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• CalPERS retirement.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

1. Develop and manage an effective Compliance Program in accordance with applicable, laws, regulations, contractual requirements, and other guidance.
2. Manage a team of professionals responsible for ensuring IEHP’s Compliance Program is continuously effective, efficient systems and processes, and strategic initiatives are executed.
3. Execute strategic compliance initiatives to enhance the overall effectiveness of the compliance program.
4. Oversee the implementation, maintenance, and optimization of compliance-related systems, applications, and reporting.
5. Manage the configuration and administration of organization’s governance, risk, and compliance management system (SAI 360) to ensure system architecture is effective and aligns with business objectives to manage regulatory requirements, risk, and obligations.
6. Manage user access, system configurations, and data integrity for compliance tools.
7. Collaborate with IT and internal reporting teams to ensure system integrations and data flows support compliance reporting needs.
8. Evaluate, investigate, and respond to potential issues of non-compliance, risks, and/or alleged violations within the Plan to address any deficiencies and mitigate risk. Develop and implement corrective action plans (CAPs) for resolution.
9. Identify opportunities for process improvement and implement solutions to streamline compliance operations.
10. Utilize data analytics to identify potential compliance risks and areas for improvement.
11. Collaborate with cross-functional teams to align compliance initiatives with organizational goals.
12. Continuously evaluate and optimize the compliance program to ensure it meets regulatory requirements and industry best practices.
13. Develop and implement key performance indicators (KPIs) to measure the effectiveness of compliance activities.
14. Design and produce comprehensive compliance reports for senior leadership, the Governing Board, and relevant committees.
15. Develop data visualization tools and dashboards to effectively communicate compliance metrics and trends.
16. Design, develop, deliver, and monitor Compliance Program Training, including Fraud, Waste and Abuse (FWA), and HIPAA Privacy & Security, to promote the elements of the Compliance Program and ensure that the whole staff is knowledgeable of and comply with applicable Federal, State, and industry standards.
17. Oversee and manage the development and review of Compliance Department Policies and Procedures, including internal and external policies in accordance with regulatory and contractual requirements.
18. Support to lead and organize Governing Board Compliance Committee and Executive Compliance Committee meetings; including ensuring relevant and necessary information is presented to allow for the Committee to support and advise the Compliance Program.
19. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.
20. Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines.

Education & Requirements 

• A minimum of seven (7) years of experience in compliance programs in a health plan or other relevant industry
• Minimum of five (5) years of experience leading analysts/compliance program related roles and compliance program activities, either in a leadership role or lead capacity
• Demonstrated experience in applying statistical data interpretation and applicability, risk assessments, compliance systems/applications, and of compliance program principles
• Proven experience in project management and leading strategic initiatives
• Experience in health care, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)and Covered California
• Bachelor’s degree in Healthcare, Business, or closely related field from an accredited institution required
  • Master's degree in Healthcare or Business from an accredited institution preferred
• Certification in Healthcare Compliance (CHC) required. (Must become certified within twelve (12) months of initial date of hire if not certified upon hire)
• Lean Certification preferred

Key Qualifications

• Knowledge of principles and practices of managed care operations
• Expert knowledge of compliance program principles and requirements
• Advanced knowledge of regulatory research and health plan regulations
• Principles and practices of project management
• Demonstrated current knowledge of business ethics and compliance risks and the knowledge to assist with management of those risks in a dynamic managed care environment
• Strong and dynamic leadership, communication, and interpersonal skills
• Exceptional decision-making skills with the ability to prioritize workload, handle multiple initiatives, and take appropriate action without direction
• Advanced proficiency in data analysis, reporting tools, and compliance management systems
• Advanced skills in Excel and data visualization tools (e.g., Tableau, Power BI)
• Strong organizational skills and experience managing multiple projects simultaneously, with competing deadlines and changing priorities
• Microsoft Office programs including, but not limited to: Word; Excel; Power Point; Outlook; Access; Power BI
• Proven ability to:
  • Maintain strict confidentiality and adhere to ethical standards in all aspects of compliance program activities.
  • Show resourcefulness, independent problem solving and self-direction.
  • Establish and maintain effective working relationships with others.
  • Manage multiple projects with competing deadlines and changing priorities.
  • Develop, analyze, and apply applicable organizational policies and programs effectively.
  • Show strong attention to detail & commitment to delivering high-quality work products.
  • Ability to analyze complex compliance data and translate insights into actionable recommendations
• General office environment; word processing and data entry involving computer keyboard, mouse, and screens
• Automobile travel within California or other states for business travel/function

Start your journey towards a thriving future with IEHP and apply TODAY!

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA)