Manager, Regulatory Data and Reporting

L.A. Care Health Plan•Los Angeles, CA

22h•$102,183 - $163,492

About The Position

L.A. Care Health Plan, established in 1997, is the nation's largest publicly operated health plan, serving over 2 million low-income Los Angeles County residents. The Manager, Regulatory Data and Reporting is responsible for overseeing an efficient team and daily operations, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. This role involves the analysis, collection, organization, and preparation of clinical and non-clinical data from internal business units and delegates (Participating Physician Groups, specialty groups, Planned Partners) for regulatory, accreditation, and contractual reporting. The Manager provides guidance on report specifications, ensures accurate data quality through quality assurance, data validation, and integrity testing, and tracks re-submissions due to errors. The position offers technical guidance to the team for completing and validating compliance reports on schedule, ensuring accuracy and adherence to regulatory requirements. The Manager advises stakeholders on reporting accuracy and oversees the regulatory report-monitoring program, collaborating with cross-functional teams to meet technical specifications for compliance reports.

Requirements

Bachelor's Degree in Nursing or Related Field (or equivalent education and/or experience)
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.
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).

Nice To Haves

Master's Degree in Nursing or Related Field
Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement.
Working knowledge of medium to advanced PLSQL are highly preferred.
Registered Nurse (RN) - Active, current and unrestricted California License
Licensed Vocational Nurse (LVN) - Active, current and unrestricted California License

Responsibilities

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.
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.
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.