Job Summary

The Manager, Regulatory Data and Reporting manages all aspects of running an efficient team, and the day-to-day operations, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. The Manager is responsible for the analysis, collection, organization and preparation of data (both clinical and non-clinical) and information submitted by L.A. Care’s internal business units and delegates, including but not limited to, contracted Participating Physician Groups (PPGs), specialty groups and Planned Partners (PPs) that is required for regulatory, accreditation and contractual reporting purposes.

This position will provide the team with guidance on the specifications of reports required by all regulators, ensuring both internal and external stakeholders implement the reports as well as assessing the accuracy of the data to ensure quality. The review of data will include quality assurance, data validation, data integrity testing and tracking re-submissions due to errors or incompleteness of data files.

This position provides technical guidance to their team to complete, validate and calculate compliance reports on an identified schedule. Ensures reports are accurate, implemented and meet the requirements of all regulators. The position advises all stakeholders to ensure complete and accurate reporting. The Manager develops and oversees the regulatory report-monitoring program.

The position works closely with key cross-functional teams to ensure compliance reports meet the technical specifications.

Duties

Manage technical data reports received from internal stakeholders and delegates. Aggregate data from delegates as needed.

Collaborate with key stakeholders on initiatives affecting L.A. Care. Communicates to leadership on any barriers to completing assignments or daily work.

Manage a robust process for data reporting through data desktop procedures, data flows, data mapping, and auditing to evaluate data accuracy and completeness.

Manage and ensure submission of regulatory report deliverables during regulatory audits/ mock audits.

Manage the development and maintenance of all regulatory report tracking schedules. Monitor and adjust reports accordingly to the current guidelines from regulatory or accreditation agencies.

Oversee the completion of regulatory reports. Collaborate with cross- functional teams to analyze and validate data, identify root cause issues and propose solutions that incorporate technology and people solutions.

Review and provide feedback on corrective action plans for the auditing and performance monitoring teams of both internal and external stakeholders regarding adverse findings.

Manage the assessment of data collection requirements assigned and provide clinical input/insight into the development as well as structured reporting of clinical data.

Support pre-delegation audits of group's clinical units prior to assigning delegated responsibilities.

Duties Continued

Establish collaborative processes with respective cross-functional teams to submit delegate data as part of L.A. Care regulatory submissions. Manage the development of reports to track end to end reporting.

Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval. Actively identifies and implements efforts to improve the quality, effectiveness, and efficiency of job functions.

Analyze and interpret contractual, state, and federal regulatory, and accreditation requirements.

Participate in and conduct compliance functions, including, but not limited to, developing compliance tools and validating implementation of new requirements and corrective action plans.

Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities. Participate in and conduct compliance functions, including, but not limited to, developing compliance tools and validating implementation of new requirements and corrective action plans.

Manage staff, including, but not limited to hiring staff, monitoring of day-to-day activities of staff, monitoring of staff performance, performance reviews, mentoring, training, and cross training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, disciplinary matters for direct reports, among others.

Maintain confidentiality in compliance with all Health Insurance Portability and Accountability Act (HIPAA) regulations.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 5 years of experience in data analysis, data integration, regulatory audit, regulatory reporting and written policy in health services/operations environment.

At least 3 years of lead (staff), supervisory or management experience in a healthcare setting.

Subject matter expertise in managed health care/services/operations.

Experience with writing business and functional design documents.

Experience managing large volumes of data sets across the healthcare industry to meet regulatory demands.

Clinical nursing experience in managed care setting.

Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.

Preferred:

Not Applicable.

Skills

Required:

Proficient in SQL, MS Access, MS Excel, MS Word and Outlook.

Ability to perform extensive root cause analysis of problem areas and recommend alternative solutions.

Strong analytical skills, attention to detail, strong oral and written communication skills, and the ability to self-start and self-motivate.

Must have solid understanding of project management methodologies and be able to assess appropriate methodologies for the work assigned to the unit.

Demonstrated ability to take responsibility for making sure requested projects meet the organizational and departmental needs with respect to data accuracy, format, and timeliness.

Ability to interpret and apply complex operating instructions, state and federal regulations, and department/division procedures.

Ability to understand, apply, and communicate rules, regulations, and guidelines to others.

Knowledgeable and up to date in industry standards and regulations

Must have excellent verbal and written communications skills and the ability to communicate effectively with internal/external management and non-management personnel.

Must demonstrate appropriate attention to detail and efficient organization skills.

Possess a professional and mature demeanor at all times.

Ability to work in a fast-paced department independently and handle multiple tasks; work with interruptions and deal effectively with confidential information.

Good working knowledge of regulatory requirements/standards, such as National Committee on Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), California Department of Health

Care Service (DHCS) and California Department of Managed Health Care (DMHC).

Preferred:

Working knowledge of medium to advanced PLSQL are highly preferred.

Demonstrated ability to take responsibility for making sure requested projects meet the organizational and departmental needs with respect to data accuracy, format, and timeliness.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information