Job description

Position Summary/Position

Under the general direction of the Manager, Regulatory Oversight, CalAIM the Regulatory Oversight Community Support Specialist is responsible for oversight and monitoring/auditing of non‐clinical Community Supports processes ensuring regulatory compliance. This position will require the use of quality auditing tools for auditing, conducting root cause analysis, identification of potential trends through root cause analysis and training topics based on trends. With the support of the Manager, this role will work closely with the Community Supports, Compliance and Quality departments to ensure that Health Services operations support regulatory compliance and quality outcomes. Major Functions (Duties and Responsibilities)

1. Stay current on all regulatory guidelines, i.e., DHCS, CMS, NCQA, DMHC which direct Community Supports nonclinical policies and processes and updates file review tools as appropriate.
2. Perform retrospective non‐clinical file reviews for Community Supports populations to identify significant and problematic quality issues and concerns. Performs root cause analysis and develops corrective action plan(s) to correct deficiencies.
3. Collaborate with Community Supports Team to aid in implementation of non‐clinical new processes or protocols as required by the corrective action plan to meet IEHP and regulatory standards.
4. Collaborate with Community Supports Team, such as Coordinators and Business Analysts, to ensure accuracy of job aids and resources to identify areas of learning opportunities for staff.
5. Assist in the development of reports and studies that will assist in the evaluation of non‐clinical Community
6. Support activities and improve outcomes that impact Community Supports.
7. Collaborate, research, and develop process changes that may need to be implemented to improve the non‐clinical Community Supports delivery processes as indicated in report and study outcomes.
8. Participate in regulatory audits, audit preparedness and process meetings as required Experience Qualifications

Minimum of one (1) year of experience in a health care setting. Minimum of one (1) year of experience in a managed care setting with experience in audits and/or quality and/or compliance. Education Qualifications

High School Diploma or GED required. Preferred Education

Associate’s degree from an accredited institution preferred. Professional Certification

Certification in Compliance (CHC), CCM, CPHQ preferred. Drivers License Required Yes, must have a valid California Driver's License. Knowledge Requirement

Knowledge of health plan regulations (DHCS, CMS, DMHC and NCQA). Knowledge of the Health Services Programs. Knowledge of Lean principles to problem solve and evaluate program effectiveness. Knowledge of Population Health Management, with heavy focus on CalAIM. Understanding of Quality Assurance. Skills Requirement

Excellent verbal and written communication skills. Ability to use Microsoft Office products (e.g., Excel, Access, PowerPoint, and Word). Skilled in public speaking. Ability to perform policy reviews and editing. Excellent interpersonal skills. Skilled in auditing and summarizing findings. Excellent time management and prioritization skills. Excellent facilitation and collaboration skills. Abilities Requirement

Ability to:

• Organize and follow through.
• Meet deadlines.
• Effectively write and verbally communicate.
• Develop and implement programs utilizing Lean principles. Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
A reasonable salary expectation is between $48,110.40 and $59,425.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

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