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Lead Compliance Monitoring/Oversight

Job ID 86020 Date posted 02/09/2018
  • Facility: Sharp HealthPlan
  • City: San Diego
  • Department: Operations
  • Category: Business Operations Jobs
  • Job Status: Full-Time
  • Shift: Day Job
  • FTE: 1.0
  • Shift Start: 8 AM
  • Shift End Time: 5 PM


This position is located in Kearny Mesa, San Diego County


8-hour shift: 8:00 am – 5:00 pm,

Required Skills and Qualifications

  • Ability to function independently, make sound decisions based upon thorough investigation of available information, manage deadlines and priorities, manage a variety of activities simultaneously.
  • Excellent knowledge of Internet and PC based software including word-processing and spreadsheets.
  • Knowledge of state and federal regulations including California Code of Regulations, especially Title 28, and the Knox-Keene Act.
  • Knowledge of health plan operations.
  • Effective interpersonal skills; excellent oral and written communication skills. Comfortable interacting with executive level positions both internally and externally.


Preferred Skills and Qualifications

  • Undergraduate degree in business, law or health care.


The Compliance Monitoring and Oversight- Lead will be responsible for serving as Sharp Health Plan’s primary resource for regulatory requirements related to the Compliance Verification and Delegation Oversight programs. Leads staff assigned to oversight projects and audit teams, providing training, work assignments, guidance, coaching and performance feedback. Maintains the compliance verification program and conducts ongoing internal oversight audits to maintain Plan compliance with state and federal regulatory requirements and government contract provisions. Coordinates the delegation oversight program for Sharp Health Plan, including review of services provided by contracted medical groups and ancillary providers. This position is also responsible for completing assigned projects related to Sharp Health Plan's compliance with state and federal laws and regulations related to health care service plans. Projects may include but are not limited to leading external audit preparation teams, implementation plans for new legislation, regulatory analysis of contractual agreements, and assessment of Plan compliance with specific regulations (e.g., evidence of coverage, provider contracts, member notices). Also responsible for preparation of regulatory filings, as directed by the Director, Legislative & Regulatory Affairs.

Sharp Health Plan offers a variety of coverage options that combine affordability and choice, while delivering high quality health care and personal service. We provide health insurance for companies of all sizes throughout the region. Members have access to valuable plan enhancements, such as interactive wellness resources, dental discounts and our exclusive global emergency services program.

Sharp Health Plan is San Diego’s only locally based commercial health plan. With a personal approach and a superior network of medical groups and physicians, Sharp Health Plan advocates for its members by providing unparalleled quality and access to health care services. It operates as a not-for-profit health plan, committed to delivering the best health care for the best value.

As one of the top-rated health plans in California (as measured by the CAHPS satisfaction survey), Sharp Health Plan serves a growing number of individuals and companies, large and small, in San Diego and southern Riverside counties.

Additional physical requirements of position may be discussed during interview.

Sharp HealthCare is proud to be an Equal Opportunity/Affirmative Action Employer.All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, transgender status, sexual orientation, protected veteran status or any other protected class.

Keywords: Regulatory, Compliance, Oversight programs, Audits, Contract, Member notices, Evidence of Coverage, Monitoring, Ancillary Providers, Knox-Keene Act, LD, Lead, Medical Groups

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