$39.18 - $58.28 hourly
Common Spirit Health
Rancho Cordova, CA
Job Summary and Responsibilities As our Senior Compliance Specialist , you will play a critical role in safeguarding organizational integrity by directing the planning, development, and implementation of a comprehensive monitoring and auditing program for contracted health plan operational functions, including utilization management, quality assurance, and network management. You will serve as a vital link between departmental leadership and regulatory bodies, ensuring that all health plan delegation oversight programs are executed with precision to support CommonSpirit Health’s commitment to departmental compliance and excellence. Every day you will lead the execution of monitoring and auditing plans to assess the compliance of Utilization, Quality, and Network Management departments with Federal and State regulations, including CMS, DMHC, and DHCS requirements, as well as NCQA accreditation standards. Your work involves conducting rigorous reviews of...