Mandates Control Specialist, Consultant

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We’re excited to share Blue Shield of California has received awards and recognition for â€" LGBT diversity, quality improvement, most influential women in corporate America, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we’re striving to make a positive change across our industry and the communities we live in â€" Join us!

Description

Job Summary

The Mandates Control Specialist, Consultant will monitor the progression of mandate implementation, validate and verify compliance, and provide visibility and transparency of enterprise-wide mandates compliance.

Responsibilities
  • Drives and manages identification and scoping of impacts across cross-functional business areas due to newly enacted or revised State and Federal Statutes; Blue Cross Blue Shield Association rules and DHCS & LA Care requirements.
  • Works collaboratively and advises diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised mandates.
  • Monitors implementation to ensure it is on track to meet compliance requirements and timelines; risks are identified; mitigation plans are developed; and escalates as appropriate.
  • Documents final compliance solutions, identified risks and mitigation plans in a controlled document.
  • Supports the implementation of quality, repeatable and documented mandate compliance processes.
  • Escalates and proposes resolution for low to moderately complex mandate and process issues.
  • Develops, prepares and presents low to medium complexity analyses, reports and recommendations to MCG Management.
  • Supports day to day operations of the Mandates Control Group.
  • Supports ongoing alignment with Blue Shield or Blue Shield Promise's strategy and company objectives.
  • Support other MCG initiatives and projects and performs other duties as assigned.
  • Other duties as assigned.




Qualifications

Knowledge and Experience
  • Typically, requires a college degree or equivalent experience and minimum 7 years of prior relevant experience.
  • Thorough experience in health care compliance, legislative or legal Services.
  • Extensive experience in healthcare compliance and Managed Care Plan operations.
  • Excellent analytical and problem-solving skills.
  • Requires deep knowledge of job area typically obtained through advanced education combined with experience.
  • Typically, viewed as a specialist within discipline. May have broad knowledge of project management.
  • Demonstrated experience reading, analyzing, and interpreting new laws and regulations, and their impact to health plan operations.
  • Demonstrated experience with complex implementations across a healthcare organization.
  • Ability to understand strategies, generate ideas and follow through on tactical execution.




Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.EEO Policy