Senior Director of Compliance

Northridge, CA

Type: Full Time

Eve Crane & Associates Inc.

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				The Senior Director of Regulatory and Health Plan Compliance (RHPC) is responsible for ensuring that case management (CM), utilization management (UM), and other departments operate in compliance with federal/state laws as well as health plan regulatory/contractual guidelines. To achieve that goal, the Senior Director will develop, implement, and maintain an internal quality monitoring program; proactively monitor readiness of business functions to meet requirements; assure timely submission of health plan reports and work plans; as well as respond to health plans for ad hoc reporting requirements, requests, audits, and corrective action plans.   The Senior Director is accountable to act as a liaison and advisor to the UM, CM and other functional business owners to enable the business units to develop and maintain compliant processes, record keeping and reporting.  The Senior Director  is also responsible for maintaining relationships with all contracted health plans' delegation oversight points of contact. Work is complex and requires a high degree of independent judgment, emotional intelligence, and personal initiative.
			
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