Regulatory Affairs & Compliance Analyst Sr. (Policies & Procedures)

About CalOptima
CalOptima is a county organized health system that administers publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. With $3.6 billion in annual revenue, CalOptima serves nearly 800,000 members, delivering services through four programs, Medi-Cal, OneCare Connect, OneCare and PACE. For the past six years, CalOptima has been rated the top quality Medi-Cal plan in California, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2019–2020.

Position Summary:
The Regulatory Affairs & Compliance Analyst, Sr. (Policies & Procedures) provides leadership, coordination, and support to ensure clear and concise communication, development, and implementation of CalOptima policies and procedures. This position is also responsible for providing technical writing and policy analysis for CalOptima’s programs. The overall objective of the position is to enhance and strengthen CalOptima’s policy infrastructure/platform/process for its programs. This incumbent will also work to ensure CalOptima’s health care program policies reflect compliance with federal, state, and contractual obligations. This position serves on projects and other assignments in the Regulatory Affairs & Compliance Department relating to policy objectives and policy initiatives. This position will interact with several levels of CalOptima staff including Executives and Management staff.

Position Requirements:
 Bachelor’s degree required, preferably in Health Services Administration, Public Health, Public Policy, or related field that would provide the knowledge
and abilities listed.
 Master’s degree preferred.
 3 years of relevant work experience in health care industry or health plan requirements, including specific experience in policies and procedure
development, Medi-Cal and/or Medicare programs required.
 3 years of experience with technical writing required.

CalOptima’s Regulatory Affairs & Compliance Analyst Sr. must possess the ability to:
 Draft policies that are clear, concise, and unambiguous along with superior writing skills.
 Communicate clearly and concisely, both verbally and in writing, and has strong presentation skills.
 Work collaboratively with internal departments to develop policies reflective of operational needs and in compliance with state and federal regulations,
and contractual requirements.
 Work with data, manipulate spreadsheets, and perform quantitative analysis.
 Demonstrate strong organizational, analytical, problem solving, and project management skills.
 Build consensus on strategies and messages among peers and stakeholders.
 Adapt to constantly changing priorities in managing various projects simultaneously.

 Work independently and as a team member on assigned projects.
 Prioritize tasks according to internal and external deadlines.
 Utilize and access computer and appropriate software (e.g. Microsoft: Word, Excel, PowerPoint) and job-specific applications/systems to produce
correspondence, charts, spreadsheets, and/or other information applicable to the position.

CalOptima’s Regulatory Affairs & Compliance Analyst Sr. must have the knowledge of:
 Knowledge of health care programs and policies, including Medi-Cal managed care.
 Principles and practices of managed care.
 Effective methods for coordinating the work of interactive groups.

For a complete job description and to apply online, please go to www.caloptima.org. Questions can be directed to Debbie Neal, Senior Recruiter, 657-235-6891 or dneal@caloptima.org

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