Sr. Compliance Strategist

Central Coast Salary Range: $117,904/annually - $176,857/annually

​​​​​​​While candidates from anywhere in California are welcome to apply, there is a strong preference for those who reside on the Central Coast (Ventura, Santa Barbara, San Luis Obispo, Monterey and Santa Cruz Counties). This role may offer opportunities for remote work; however, familiarity with and proximity to our local customers is valued.

Job Summary

The Senior Compliance Strategist will provide organization-wide leadership for Compliance Division-led initiatives that align with regulatory requirements, business objectives, and the organization’s strategic plan, through program development and strategic tactics. This role will help drive the implementation and continuous improvement of the organization’s Compliance Program and Enterprise Risk Management Program. The Senior Compliance Strategist will be expected to work with independence, drive successful completion of Compliance-led initiatives and tactics, and leverage subject matter expertise to make recommendations to leadership to inform decision-making.

Duties and Responsibilities

• Leads and manages the cross-functional planning and implementation of Compliance Division-led initiatives, ensuring alignment with CMS, DMHC, and NCQA regulatory requirements, compliance with contractual requirements, federal and state statutes and regulations, state and federal program requirements, and accreditation standards, through engagement with executive leadership, management, department leaders, and impacted stakeholders.

• Drive the design, implementation, and continuous improvement of the organization’s Compliance Program and Enterprise Risk Management Program.

• Drive the development of the organization’s risk universe, annual audit work plan, and risk assessment.

• Serve as a strategic partner to senior leadership, providing guidance on compliance risks, trends, and mitigation strategies.

• Provide clear and actionable compliance updates to leadership and cross-functional teams.

• Partner with operational, clinical, and other departments to ensure successful completion of Compliance-led strategic initiatives through management of key deliverables and alignment with the organization’s strategic plan.

• Provides recommendations and guidance based on subject matter expertise to leadership, management, and key stakeholders.

• Maintains current awareness of healthcare and health plan compliance laws, regulations, and standards, as well as related industry developments in order to ensure continuous subject matter expertise.

• Represents AMO in compliance program initiatives.

• Reports up to Director for risk assessment and risk plan development.

• Drives maintenance of AMO policies/procedures.

• Other related projects and duties as may be assigned.

Primary external contacts may include CMS, DMHC, DHCS, NCQA, other County Organized Health Systems and Medi-Cal plans, and industry organizations such as the California Alliance of Health Plans (CAHP) and Local Health Plans of California (LHPC)

Knowledge/Skills/Abilities

• Strong understanding principles of Medi-Cal managed care and regulatory, accreditation, and compliance processes impacting managed health care.

• Strong understanding of Medicare requirements, policies, and processes.

• Strong understanding of federal and state regulatory and accreditation bodies and processes.

• Understanding of CenCal Health’s operations and processes a plus.

• Advanced