COMPLIANCE ANALYST- Full Time

Job Description This Compliance Analyst role ensures compliance with CMS, DHCS, DMHC, and other regulatory requirements. The analyst assists with Health Plan audits concerning Utilization Management programs and ensures timely audit submissions for UM, Claims, Credentialing, and other delegated functions. The analyst collaborates with and may lead cross‑functional teams to ensure activities comply with regulatory and contractual obligations, researches and investigates potential non‑compliance, escalates concerns to the Delegation Oversight Supervisor, audits referrals for regulatory compliance, and ensures staff compliance with the Language Assistance Program for Limited English Proficiency members. Summary The Compliance Analyst ensures compliance with the timeliness of decisions, initial notifications, and written notifications following the Centers for Medicare and Medicaid Services (CMS), the Department of Health Care Services (DHCS), the Department of Managed Health Care (DMHC), and other regulatory and accrediting bodies requirements and standards. The Analyst assists with Health Plan audits concerning the Utilization Management (UM) program and processes and ensures timely audit submissions for UM, Claims, Credentialing, and other delegated functions. Collaborates with, takes part in, or may lead cross‑functional teams to ensure delegated activities follow regulatory and contractual obligations. Researches, investigates, and identifies actual and/or potential non‑compliance with standards and escalates concerns to the Delegation Oversight Supervisor. Audits and reviews referrals to ensure compliance with regulatory requirements. Ensures staff complies with Language Assistance Program Requirements for LEP members. Responsibilities Ensure compliance with the timeliness of decisions, notifications, and written notices as required by CMS, DHCS, DMHC, and other bodies. Assist with Health Plan audits concerning the Utilization Management program and other delegated functions. Collaborate with, take part in, or lead cross‑functional teams to ensure activities follow regulatory and contractual obligations. Research, investigate, and identify potential non‑compliance and escalate concerns to the Delegation Oversight Supervisor. Audit and review referrals for compliance with regulatory requirements. Ensure staff compliance with the Language Assistance Program Requirements for Limited English Proficiency members. Qualifications To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Education and/or Experience High school diploma or general education degree (GED) and at least one year related experience and/or training required. Prefer two years of experience in health plan/UM operations, managed care/medical group operations, independent physician association (IPA) operations, MSO operations, or healthcare auditing. Familiarity with, or intermediate skills in, Excel, data management, data validation, data analyses, and process mapping. One year of experience in delegation oversight audits, monitoring, and tracking highly desired. Certificates, Licenses, Registrations None. Language Skills Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization. Mathematical Skills Ability to calculate amounts and figures such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry. Work Environment The noise level in the work environment is usually moderate. Benefits Challenging and rewarding work environment Competitive compensation and paid time off Excellent medical, dental, vision, and life insurance plans Company match and discounted stock plan EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr Riverside Medical Clinic