Regulatory Analyst - Managed Care in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 8/15/2019

Job Snapshot

Job Description

At Scripps Health, you will experience the pride, support and respect of an organization that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.

You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.

Scripps Health is looking for a Regulatory Analyst to join their fast paced, collaborative strong team. The Regulatory Analyst is an integral part of team who promotes compliance with laws, regulations and fosters the highest standards of integrity and ethical conduct. Responsibilities include project management for compliance initiatives and implementations, compliance monitoring, compliance training/education, compliance reporting and filings with the DMHC, collaborating and consulting with business leaders, and staying current with changing regulatory requirements.

As the Regulatory Analyst for Managed Care it will be your responsibility to manage sensitive and confidential information and materials in support of the various daily managed care, regulatory filings, and delegation oversight activities. You will perform diagnostic project based analysis, risk assessments, monitoring state federal and managed care regulations, investigations and audits. Perform audits related to Scripps confidential information, which includes protected health information, delegation oversight, and regulatory information. Activities in the role include reviewing various systems, medical records and other documentation to assess adherence to established Scripps policies related to privacy, regulatory compliance and delegation oversight of confidential information. In your role, it is your responsibility to assemble and analyze activity information and/or data and prepare written reports that will be viewed by senior management. You will need to use independent judgment in completing activities researching laws and regulations as they relate to managed care compliance privacy and impact on managed care policies, procedures, regulatory filing and delegation oversight.

This is a Full Time, Monday – Friday Salaried position, located at our 4S Ranch/Rancho Bernardo Business Services office.

Job Requirements

Required Education/Experience/Specialized Skills:
  • 3 years of experience in healthcare regulatory, privacy, compliance, delegation or equivalent experience in the related health care field.
  • Ability to interpret laws regulations and identify and propose policy and procedure changes as needed.
  • Excellent command of English language, grammar and written/ oral communication and interpersonal skills required.
  • Experience in health care setting related to patient privacy and/or protection of confidential information (including protected health information).
  • Technical knowledge of privacy concepts, confidential information internal controls and safeguards, technologies, and applicable rules and regulations.
  • Understanding of state, federal, and NCQA requirements related to an integrated healthcare delivery environment.
  • Must demonstrate good analytical skills and the ability to work in highly computerized work environment.
  • Proficient computer skills including demonstrated ability to use the Internet and experience using the following applications: Outlook, Excel, Word, PowerPoint and Access.
  • Ability to create and maintain spreadsheets and forms to promote analytical efficiency and consolidation of audit information.
  • Proven ability to draft written reports of audit results.
  • Detail-oriented skills including proven ability to edit and proofread own work.
  • Proven fast and accurate word processing skills.
Preferred Education/Experience/Specialized Skills/Certification:
  • Bachelor's degree.
  • Certified in Healthcare Compliance (CHC), active pursuit of certification is desired.
  • Must demonstrate an understanding of health care regulations related to managed care compliance, patient privacy, protection of confidential information, regulatory and delegation oversight activities.
Scripps Health is repeatedly named on the Fortune Magazine’s 100 Best Companies to work for, only San Diego-based company and Becker’s Healthcare Top Hospitals. Scripps Health offers a robust Total Rewards Program designed to compensate and motivate you throughout your career. Scripps Health Total Rewards Program includes a broad range of plans and programs including market competitive pay and performance incentives, health and wellness benefits, financial wellness benefits, work-life resources, learning and development opportunities, and rewards and recognition. Unlock your potential with Scripps Health today.

Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, age, status as a protected veteran, among other things, or status as a qualified individual with disability.