Sr. Manager, Mandates Control

Your Role

The Mandates Control Group team is responsible for analyzing new laws and regulations, identifying the implications, and affected business areas, including business subject matter experts, preparing a work order for the project management team and/or the business to execute, and validating compliance artifacts once implementation is complete. The Senior Manager, Mandates Control Group will report to the Director, Mandates Control Group. In this role you will be accountable for end-to-end mandate intake activities, scoping for implementation and validation oversight. The Sr. Manager will lead a mid-sized team of experienced professionals and will be responsible for influencing a mandates compliance culture enterprise-wide, ensuring that compliance with mandates is non-negotiable and that 100% mandates compliance is achieved and sustained. 

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Develop, implement, and provide day-to-day leadership for processes and tools to support and enhance Mandates Control Group operations

• Ensure mandate impacts are appropriately scoped at the enterprise level and selected compliant options are legally compliant, fiscally responsible, and operationally sustainable

• Ensure impacted business units and stakeholders, business impact statements, identified risks and mitigation plans are documented in a controlled document

• Advise business areas on mandate compliant options; ensure implementation timing, risks and benefits are identified, escalated, and mitigated

• Serve as an escalation point for at risk or non-compliant mandates

• Recognize where compliance is met or corrective action plans are implemented to close identified gaps

• Manage and monitor work of Mandates Control Group staff, providing coaching, guidance and leadership

• Support ongoing alignment with Blue Shield of CA and Blue Shield of CA Promise strategy and company objectives, as well as interdependencies across business units

• Advance a culture of business accountability and solve for gaps in business accountability for mandates compliance

• Advocate and influence across the organization to drive key initiatives of the Mandates Control Group

• Perform other duties as assigned

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience and minimum 10-years prior relevant experience, including 4 years of management experience 

• Requires deep understanding of health insurance operations, healthcare compliance, mandates, regulations, and legislative requirements across all lines of business (commercial, Covered CA, self-funded, and Medicare)

• Requires deep understanding of health insurance operations, healthcare compliance, mandates, regulations, and legislative requirements of the Department of Health Care Services and Medi-Cal

• Requires practical knowledge in leading and managing the execution of processes, projects, and tactics within Mandates

• Requires advanced technical and functional expertise, business acumen, financial analysis skills, risk management, delegation skills, critical thinking, and decision-making skills

• Requires full understanding of applicable legislation/regulations and has demonstrated experience in ensuring departmental compliance

• Requires thorough knowledge of the Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes

• Extensive experience in a legal or compliance department in a managed care organization preferred.