Care Delivery and Clinical Oversight Compliance, Program Manager

SCAN Health Insurance•Long Beach, CA

6d•Onsite

About The Position

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve. The Job The Program Manager is a member of the Health Plan Corporate Compliance department and is responsible for overseeing and monitoring the clinical quality and regulatory compliance performance of the organization’s wholly owned care delivery assets. The role serves as the primary liaison between Corporate Compliance, the medical groups’ leadership, and other enterprise functions (e.g., Quality, Operations, Network, Risk Adjustment) to ensure alignment with Medicare Advantage, Medicaid, and state regulatory requirements, as applicable. This position drives the design, implementation, and continuous improvement of a structured oversight program that proactively identifies, mitigates, and reports compliance and quality risks. You Will Serve as a compliance partner to the health plan’s care delivery assets, offering clear, practical guidance tailored to each care delivery assets’ operations, including PACE.

Requirements

Bachelor's Degree in healthcare administration, nursing, health policy, public health, or related field or equivalent experience
5+ years of experience in healthcare compliance, medical group operations, quality, or related field.
In-depth knowledge of Medi-Cal managed care requirements, DHCS contractual obligations, CMS, and PACE.
Hands-on experience supporting or working within a medical group, IPA, FQHC, or delegated entity.
Strong understanding of Medicare Advantage, FDR requirements, CMS regulations, audit processes, and corrective action management.
Ability to translate complex regulatory standards into operational guidance appropriate for front-line medical group teams.

Responsibilities

Oversight Program Design and Governance: • Develop and maintain a comprehensive oversight framework for the care delivery assets that covers regulatory compliance, clinical quality, patient safety, and operational performance.
Define and maintain policies, procedures, and standards for delegated oversight, including charters, escalation pathways, and governance routines (e.g., joint oversight committees, workgroups, and reporting cadence).
Collaborate with Legal, Quality, Operations, and Network Management to ensure oversight requirements are incorporated into medical group service agreements, operating models, and SLAs.
Monitoring, Auditing, and Reporting: • Develop and execute an annual risk-based monitoring and audit plan for the medical groups, focusing on areas such as utilization management, access and availability, care coordination, documentation and coding integrity, grievances and appeals, patient safety, and adherence to clinical guidelines.
Establish performance dashboards and key performance indicators (KPIs) for regulatory compliance and clinical quality, and ensure timely, accurate reporting to Corporate Compliance leadership, the Compliance Committee, and relevant Board committees.
Track findings, corrective actions, and timelines; work with care delivery assets’ leadership to ensure effective root cause analysis, sustainable remediation, and ongoing monitoring.
Coordinate readiness and documentation for internal and external audits/assessments related to the care delivery assets (e.g., CMS program audits, state surveys, accreditation reviews, OIG or other regulatory inquiries).
Regulatory and Clinical Quality Expertise: • Maintain current knowledge of applicable federal and state regulations and sub regulatory guidance (e.g., Medicare Advantage rules, CMS manuals, NCQA standards, state Department of Insurance/Department of Managed Health Care requirements, HIPAA, fraud/waste/abuse requirements).
Partner with Clinical Quality and Medical Management to align oversight activities with HEDIS/Stars, patient safety initiatives, and clinical quality improvement projects.
Provide interpretation and practical implementation guidance to care delivery assets’ leaders on new or changing regulatory and accreditation requirements.
Stakeholder Engagement and Relationship Management: • Serve as the primary corporate point of contact for care delivery assets on compliance and clinical quality oversight matters.
Facilitate regular joint meetings to review performance, discuss risks and issues, and agree on action plans.
Support culture building efforts to reinforce accountability, transparency, and a strong “tone at the middle” within the care delivery assets.
Issue Management and Corrective Action: • Coordinate intake, triage, and investigation of potential compliance or quality issues arising from the care delivery assets, ensuring appropriate documentation, escalation, and remediation.
Work with care delivery assets and health plan leaders to design and implement corrective action plans, including specific metrics, owners, and timelines.
Monitor effectiveness of corrective actions; adjust oversight intensity based on risk level and demonstrated performance.
Project and Change Management: • Lead cross functional initiatives that impact both the health plan and care delivery assets (e.g., new regulatory requirements, model of care changes, benefit design changes affecting care delivery, AI/technology implementations touching clinical workflows).
Apply structured project management methodologies to ensure clear scope, stakeholder alignment, risk mitigation, and timely delivery.
Develop and manage project plans, status reports, and communications tailored to executive, operational, and clinical audiences.
Training and Education: • Identify compliance and clinical quality training needs across the care delivery assets and coordinate the development and delivery of targeted education (e.g., documentation and coding, UM decision making, grievance/appeal handling, documentation of medical necessity, fraud/waste/abuse awareness).
Evaluate the effectiveness of training and adjust content or delivery methods based on outcomes and feedback. Reinforce an organizational culture of compliance, quality, and ethical conduct.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base Pay Range: $106,200 to $153,705 annually
Work Mode: Mostly Onsite (In the Long Beach, CA office Tuesdays and Wednesdays)
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO) along with 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
Excellent 401(k) Retirement Saving Plan with employer match
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!
A competitive compensation and benefits program;
An annual employee bonus program;
Generous paid-time-off (PTO);
Eleven paid holidays per year;
Excellent Retirement Savings program;
A work-life balance;
An opportunity to become part of a team that makes a difference to our members and our community every day!