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Health Plan Regulatory Services (HPRS) is responsible for leading CA state regulatory initiative across all functions statewide, as well as managing relationships and maintaining communication with stakeholders at all levels, both internally and externally.
Essential Functions:
- Manages, creates, and maintains client relationships.
- Fosters comprehensive regulatory management through a series of activities to comply with all applicable regulations and statutes. Activities include.
- Planning: identifying and may lead the identification of regulatory accountabilities; identifying and may lead the identification of internal and external resources; developing and/or overseeing the development of regulatory work plans; participating on and may establish regulatory-related committees/work groups; and managing external agency relations.
- Implementing: identifying regulatory requirements and conducting related analyses; creating or revising regulatory standards, policies, and procedures; developing and/or conducting regulatory training; monitoring regulatory adherence; and reporting on regulatory efforts and programs.
- Validating: reviewing regulatory programs and content, including designing and conducting risk assessments for survey readiness, and investigating instances of reported non-compliance with regulatory standards.
- Researches and stays abreast of regulations and statutes.
- Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training.
- Communicates required changes, develops tools to assess risks, and leverages existing workgroups/etc. to facilitate required changes.
- Works on assignments of diverse and complex scope.
- Interprets less defined guidelines to make recommendations for process improvements and/or enhancements.
- Requires complex planning to coordinate with other departments or resources.
- Responsibilities impact the achievement of key functional and/or KP objectives that have direct and significant business impact.
- Contributes to the development of the department's objectives.
- Erroneous decisions or recommendations would normally result in the inability to reach functional objectives and negatively affect expenditures and resources.
- Involves interpreting and analyzing established concepts and trends and may involve a high degree of interpretation and analysis of obscure or inconclusive data.
- Exercises considerable judgment to make decisions for less defined and complex issues.
- Requires complex decision-making.
- Develops solutions to a diverse range of complex problems, which require creativity and innovation within broadly defined policies and practices.
- Requires in-depth analysis to identify and recommend new solutions for more complex problems.
- Provides professional/technical guidance to team member, presents complex information throughout the organization.
- Influences others to buy into new concepts and methodologies, and may work to gain cooperation and acceptance/approval in resolving problems, and/or negotiating with other parties to arrive at an agreement.
- Exercises considerable latitude in determining objectives and approaches to assignment.
- Work is accomplished without considerable direction.
- Work is evaluated upon completion to ensure objectives and performance requirements have been met.
- Assume other duties as directed.
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