Director, Regulatory and Managed Care Compliance, DentaQuest (California)

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

Location: Must reside in California

The Opportunity:

The Director, Regulatory and Managed Care Compliance reporting to the AVP California Dental Operations, will provide a broad range of compliance services in support of the overall enterprise and will lead compliance initiatives within their respective business division and region.

How you will contribute:  

• Develop and maintain key relationships with the regulatory agencies, including but not limited to the California Department of Managed Health Care (DMHC) and Coordinated Care Organizations (CCOs) in their respective business division and region.
• Ensure compliance with all state regulatory and CCO audits in their respective business division and region.
• Coordinate corporate attendance and participate in all regular compliance and quality management meetings required in the Western Region.
• Ensure timely and accurate reporting and audit responses to all regulatory agencies and CCOs.
• Assume lead role in all tasks associated with compliance related matters.
• Direct and conduct investigations of potential compliance issues and development and implementation of any necessary corrective action plan.
• Direct and enforce all compliance policies and procedures and consistent application of sanctions for failure to comply.
• Monitor, research federal and state regulations and proposed regulations to determine applicability for the organization and/or business division and region and develop and execute strategies and proposed improvements or changes to current state.
• Develop, implement, and conduct periodic privacy risk assessments and related monitoring activities in coordination with Internal Audit and Compliance Program monitoring activities.
• Assume lead role in development and implementation of Fraud, Waste and Abuse deliverables, including FWA prevention handbook, annual prevention plan, quarterly reporting and annual assessment.
• Other duties as needed or required.

What you will bring with you:

• BA or BS degree in related field required
• 5+ years’ experience with Managed Care and/or CCO programs and compliance.
• Healthcare/dental management or administration or related field preferred
• Ability to assume a reasonable level of individual responsibility, to handle multiple projects and responsibilities at the same time and to work collaboratively in a nonhierarchical department structure.
• Ability to building strong relationships with leadership, industry partners and regulatory entities to maintain and further develop the Organization’s strong culture of ethics and compliance at all levels in the organization
• Strong understanding of legal and regulatory knowledge and experience in operational implementation
• Demonstrated knowledge and understanding of emerging trends and regulatory requirements
• Detail-oriented individual with excellent analytical, organizational, problem-solving, and interpersonal skills.
• Excellent interpersonal skills and demonstrated ability to work collaboratively on a team among diverse groups
• Exceptional written and verbal communication skills.
• Ability to develop and/or interpret complex regulatory requirements and the ability to communicate technical and complex concepts.
• Attends additional training as requested/deemed necessary

Salary:  $132,600 - 198,900
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determi