Quality and Compliance Manager CA - Remote

United States·FresnoFull Timemid

Legal & ComplianceCompliance Specialist

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Quick Summary

Requirements Summary

20% About MedZed MedZed is a leader in delivering value-based, technology-enabled social support to high-cost Medicaid members who are unreachable and disconnected from their primary care provider.

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Legal & ComplianceCompliance Specialist

Responsibilities

~1 min read

→Design and maintain a regulatory compliance monitoring calendar covering DHCS, DMHC, CMS, and applicable county contract requirements.
→Conduct ongoing monitoring of federal and California regulatory changes; assess operational impact and drive timely policy updates.
→Develop and manage risk matrices for regulatory and contract obligations; escalate material risks to the VP of Quality & Compliance.
→Coordinate responses to regulatory inquiries, desk reviews, and on-site surveys; prepare supporting documentation and track findings to resolution.
→Monitor compliance with Medi-Cal managed care contract terms, IHSS program requirements, and other payer or county obligations.

Build and maintain an internal compliance controls library, including policies, procedures, attestations, and audit tools.
Conduct routine internal audits and testing across clinical operations, billing, documentation, and vendor management.
Lead root cause analysis for compliance findings; develop and track corrective action and performance improvement plans (CAPs/PIPs).
Coordinate with department managers to embed compliance controls into day-to-day workflows and onboarding processes.
Maintain compliance issues log and produce monthly dashboards for leadership review.

Review and assess new and renewing contracts for compliance risk, including payer agreements, subcontractor arrangements, and vendor contracts.
Maintain contract obligations tracker; monitor adherence to reporting deadlines, notice requirements, and performance standards.
Partner with legal counsel and operations on contract language related to HIPAA, scope of services, and regulatory compliance.
Support rate negotiations and program expansions with compliance impact analyses.

Develop and deliver compliance training for Community Health Navigators (CHNs) and program staff, including annual and role-specific curricula.
Maintain a training completion tracking system and report gaps to the VP of Quality & Compliance.
Act as a day-to-day compliance resource for field staff, responding to questions and escalating issues as appropriate.

Prepare compliance reports, board updates, and regulatory submissions as directed by the VP.
Maintain organized, audit-ready compliance records and documentation in accordance with retention policies.

Requirements

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This position requires the employee to remain in a stationary position for prolonged periods while performing desk-based computer tasks.
The employee must be able to constantly operate a computer, keyboard, and other office productivity machinery, such as a calculator, copy machine, and computer printer.
The person in this position may need to occasionally move about inside the office/remote workspace to access file cabinets, office machinery, or other resources.
The employee may occasionally be required to lift and move objects weighing up to 10 pounds (e.g., a laptop, files, or small office equipment).
Clarity of vision at approximately 20 inches or less is required for working with computers and reading small print.

3+ years of direct experience in compliance monitoring, regulatory risk controls, and contract risk management in a healthcare setting.
3+ years managing internal compliance controls, including audit functions, corrective action plans, and controls documentation.
Demonstrated knowledge of California healthcare regulatory environment, including Medi-Cal, DHCS requirements, and managed care contract compliance.
Experience working in or alongside in-home healthcare, community-based services, or a similar field-operations model strongly preferred.

Bachelor’s degree in healthcare administration, Public Health, Business Administration, or a related field required.
Master's degree (MHA, MPH, MBA) or Juris Doctor preferred.
Certified in Healthcare Compliance (CHC) through the Health Care Compliance Association (HCCA) or Certified Internal Auditor (CIA) through the Institute of Internal Auditors preferred.

Demonstrated ability to manage multiple workstreams in a dynamic program management environment.
Ability to work with and through others in a matrixed leadership role.
Strong command of federal healthcare regulations, including HIPAA, ACA, and Medi-Cal managed care rules.
Skilled in building and managing compliance frameworks, risk matrices, and audit programs from the ground up.
Ability to translate regulatory requirements into clear, operational policies and staff-facing training.
Excellent written and verbal communication; able to present complex compliance information to non-technical audiences.
Proficient in Microsoft 365 (Excel, Word, SharePoint); experience with compliance management systems or GRC platforms a plus.
Bilingual (English/Spanish) a plus given the populations MedZed serves.

This is a hybrid position based in California. The Quality and Compliance Manager is expected to be available for periodic on-site visits to operational locations, county meetings, and regulatory site visits. Some evening or weekend availability may be required during audit or survey periods. Travel within California up to 20%.