Serve as the primary owner and administrator of Operations policies and procedures maintained within the organization's policy management application.
Coordinate the creation, revision, review, approval, publication, and retirement of departmental policies and procedures.
Maintain an accurate inventory of Operations policies and procedures and ensure all required review cycles are completed timely.
Establish and maintain document version control, review schedules, approval workflows, and governance standards.
Monitor policy and procedure compliance with organizational requirements and established documentation standards.
Ensure all policies and procedures remain audit-ready and readily accessible.
Maintain knowledge of regulatory requirements affecting Operations functions, including Medi-Cal, D-SNP, Medicare Advantage, and managed care operations.
Analyze changes in regulatory, contractual, accreditation, and operational requirements and incorporate necessary updates into policies and procedures.
Ensure policies accurately reflect requirements issued by: DHCS CMS NCQA State and federal regulatory agencies Internal organizational governance bodies.
Support departmental readiness for audits, accreditation reviews, regulatory examinations, and compliance assessments.
Draft, edit, and maintain policy and procedure content using clear, concise, and consistent language.
Perform detailed copyediting and quality assurance reviews of Operations policies and procedures as well as JAMs, DLPs, and SOPs.
Ensure consistency in terminology, formatting, structure, readability, and policy language across all Operations documentation.
Validate policy content through collaboration with subject matter experts and operational leaders.
Recommend improvements to policy clarity, organization, and usability.
Facilitate policy review and update discussions with Operations leadership and subject matter experts.
Coordinate policy approvals and publication activities.
Provide consultation and editorial guidance regarding policy alignment for related operational documentation.
Serve as a departmental resource for policy interpretation, organization, and documentation standards.
Requirements:
Bachelor’s degree in Healthcare Administration, Business, English, Journalism, or a related field (or equivalent work experience)
5-7 years of experience in health plan operations, vendor oversight, or compliance
Minimum 3-5 years of experience in Managed Healthcare Operations and/or Government Relations/Compliance must be added in lieu of a bachelor’s degree
Strong understanding of Medi-Cal and/or Medicare managed care requirements
Strong written and verbal communication skills
Ability to manage multiple priorities and meet deadlines
Data analysis and reporting skills required
Advanced computer skills in MS Office products
A valid and current Driver's License, Auto Insurance, and professional licensure(s) if travel is required.