Kaiser Permanente
Regulatory Consultant II, Health Plan Regulatory Services (HPRS)
Kaiser Permanente is looking for a Regulatory Consultant II in the Survey Readiness group, which is responsible for conducting annual and periodic focused assessments or evaluations in the various operational areas to ensure continuous survey readiness and to identify risks across the organization. Responsibilities also include providing consultative services to areas and/or work streams as it relates to changes in healthcare laws on the local, state, or federal level.
Essential Functions:
- Leads and/or participates in audit/assessment activities as part of HPRS' oversight and monitoring of specific operational areas such as Quality, Member Services, Claims, and Utilization Management in preparation for Department of Managed Health Care (DMHC) and other regulatory entities.
- Manage, create, and maintain client relationships
- Identify risk and inform leadership as needed.
- Attends Member Issue Resolution Committee meetings and provides consultation on members' complaint and grievance cases. Serves as an expert resource on behalf of HPRS.
- Provides regulatory consulting on a wide range of requests using knowledge of health plan policies and procedures, the Knox-Keene Act, Title 28 and Title 22.
- Responsible for project management activities relative to their own assignments as well as new initiatives and activities.
- Researches and stays abreast of regulations and statutes. Understands the impacts of regulations on operational areas.
- 20-25% travel within Northern California
Qualifications:
Basic Qualifications:
- 5+ years of experience in health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience
- Bachelor's degree or 4 additional years of equivalent experience
- Thorough knowledge of health care regulatory policies, practices, and systems
- Complete understanding of state and federal regulatory concepts
- Full knowledge of health care industry practices and standards
- Ability to draft and revise documents including policies, standards, analyses, and reports
- Project management skills
Preferred Qualifications:
- Knowledge of Health Care Reform
- Adaptable to changes and multi-tasking
- Audit and/or compliance experience
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.