Job Description:

• 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.

Benefits:

• Health insurance
• 401(k) matching
• Flexible work hours
• Paid time off
• Professional development opportunities