Job Description
Job Description Your Role The Promise Medi-Cal Compliance team oversees and coordinates Blue Shield Promise Health Plan's (BSCPHP) compliance program. The Government Programs Compliance Specialist, Consultant will report to the Government Programs Compliance Senior Manager. In this role you will provide assistance with driving and managing the identification and scoping of impacts across cross-functional business areas due to ongoing, newly enacted, or federal and state regulatory requirements.
Responsibilities Your Work In this role, you will:
- Provides assistance with driving and managing the identification and scoping of impacts across cross-functional business areas due to ongoing, newly enacted, or federal and state regulatory requirements
- Work collaboratively and advises diverse business areas across the enterprise on the development of legally compliant solutions for newly enacted or revised Medi-Cal requirements
- Support the implementation of quality, repeatable, and documented CMS, DMHC and DHCS regulatory compliance processes
- Conduct decision-making guided by resource availability and functional objectives
- Conduct audits of complex issues independently
- Conducts calibration of risk and controls with business units supporting the Medi-Cal line of business
- Escalates and proposes resolution for low to moderately complex CMS, DMHC and DHCS regulatory and process issues
- Develops, prepares, and presents low to complex analyses, reports, and recommendations on Medi-Cal requirements to department management
- Supports day-to-day operations of the Medi-Cal Compliance department
- Supports other Medi-Cal Compliance department initiatives and projects
Qualifications Your Knowledge and Experience - Requires a college degree or equivalent experience
- Requires a minimum of 7 years of prior relevant experience
- Requires extensive experience in the compliance department for a managed care health plan
- Extensive and expert knowledge of Knox-Keene Act, California Code of Regulations Titles 22 and 28, and Code of Federal Regulations Title 42 regulatory compliance standards and processes
- Strong analytical and investigative skills including risk assessment, mitigation and corrective actions plans
- Experience working directly with the California Department of Health Care Services and the California Department of Managed Health Care
- Competent in Excel, PowerPoint, and SharePoint
- Professional certifications and additional degrees a plus
About the Team About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values: - Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model: At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
- Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
o Member-facing and approved out-of-state roles remain remote.
o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
- On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
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.
Please click here for further physical requirement detail.
Equal Employment Opportunity: 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.
Job Tags
Full time, Part time, Work at office, Local area, Remote work, Work from home, Home office, 1 day per week,