Come Grow With Us
At Gold Coast Health Plan, we are driven to create the health plan of the future - today. We are disrupting the conventions of the health care industry by creating and applying leading-edge solutions to its many challenges.
Working at Gold Coast Health Plan means working alongside a team of committed individuals who are reshaping the organization and redefining how the needs of the whole person – health, health care, and social services and supports – are met. We are seeking collaborators, innovators, and those who are driven to be their very best.
If you are looking for a career of purpose and are passionate about having an impact on society’s health care challenges, then Gold Coast Health Plan is where you should be. Here, you will be challenged and rewarded in equal measure.
About this role:
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
**This role is open to California residents only.**
ESSENTIAL FUNCTIONS
Job Function & Responsibilities
Policy and Procedure Governance
- 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.
Regulatory and Compliance Oversight
- 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:
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DHCS
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CMS
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NCQA
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State and federal regulatory agencies
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Internal organizational governance bodies
- Support departmental readiness for audits, accreditation reviews, regulatory examinations, and compliance assessments.
Writing, Editing, and Quality Review
- 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.
Stakeholder Collaboration
- 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.
MINIMUM QUALIFICATIONS
Education & Experience:
Bachelor’s degree in Healthcare Administration, Business, English, Journalism, or a related field (or equivalent work experience) Preferred but not required
- 5-7 years of experience in health plan operations, vendor oversight, or compliance.
Equivalent In lieu of degree:
Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.
- 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.
KNOWLEDGE, SKILLS & ABILITIES
Preferred Qualifications:
- Strong understanding of Medi-Cal and/or Medicare managed care requirements.
- Experience in a lead or senior role preferred.
- Strong written and verbal communication skills.
- Ability to manage multiple priorities and meet deadlines
- Data analysis and reporting skills required.
- Ability to manage multiple priorities and meet deadlines
Technology & Software Skills: Advanced computer skills in MS Office products
Certifications & Licenses: If travel is required, include: A valid and current Driver's License, Auto Insurance, and professional licensure(s)
Competency Statements
- Management Skills - Ability to organize and direct oneself and effectively supervise others.
- Business Acumen - Ability to grasp and understand business concepts and issues.
- Decision Making - Ability to make critical decisions while following company procedures.
- Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.
- Interpersonal - Ability to get along well with a variety of personalities and individuals.
- Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
- Time Management - Ability to utilize the available time to organize and complete work within given deadlines.
- Consensus Building - Ability to bring about group solidarity to achieve a goal.
- Relationship Building - Ability to effectively build relationships with customers and co-workers.
- Presentation Skills - Ability to effectively present information publicly.
- Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.
- Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.
- Judgment - The ability to formulate a sound decision using the available information.
- Communication, Oral - Ability to communicate effectively with others using the spoken word.
- Communication, Written - Ability to communicate in writing clearly and concisely.
- Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
The estimated pay range for the position is:
$91,667.00 - $128,333.00
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.
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