Job Details

Organizational Description

The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health. In order to help our health centers, meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

Position Title: Regulatory Affairs Manager

Department: Compliance

Reports To: Senior Director of Compliance / Compliance Officer

Classification: Remote/Office (Hybrid)

Status: Exempt

POSITION SUMMARY

The Regulatory Affairs Compliance Manager is responsible for ensuring organizational compliance with federal and state healthcare regulations, with a focus on Medi-Cal Managed Care, D-SNP, and delegated entity operations. This role bridges regulatory strategy and operational compliance by monitoring legislation, managing regulatory change, overseeing policy governance, and supporting audit readiness. The position also includes oversight of external auditing functions for First Tier, Downstream, and Related Entities (FDRs) to ensure delegated compliance. It encompasses responsibilities that draw upon prior experience in regulatory affairs and compliance within managed care or delegated healthcare settings.

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned.

Regulatory Affairs & Change Management

• Monitor and analyze state and federal legislation, including California Senate and Assembly bills, that impact Medi-Cal, D-SNP, and delegated healthcare operations.
• Monitor and analyze regulatory updates and guidance from Medi-Cal (DHCS), CMS, and NCQA to assess organizational impact and ensure timely implementation.
• Utilize a combination of compliance tools and/or software solutions to support the tracking, analysis, and dissemination of regulatory and legislative changes; may include developing or customizing tools to meet organizational needs.
• Interpret regulatory updates and assess organizational impact.
• Serve as a liaison with regulatory agencies (e.g., DHCS, DMHC, CMS).
• Lead enterprise-wide implementation of new or revised regulatory and contractual requirements.
• Coordinate with internal stakeholders to ensure timely and effective compliance.

Policy & Procedure Oversight

• Oversee the development, review, and maintenance of enterprise policies and procedures.
• Ensure alignment with current regulatory and contractual obligations.
• Maintain and manage a centralized policy repository using a policy management system integrated with internal platforms to ensure accessibility, version control, and audit readiness.

Audit & Readiness

• Support internal and external audits, including pre-delegation, readiness, and FDR oversight.
• Coordinate corrective action plans and follow-up activities.
• Develop and implement auditing tools and templates to support internal and external compliance monitoring efforts.

Risk & Incident Management

• Support the Compliance / Privacy Officer in the identification, triage, and documentation of potential regulatory or privacy-related incidents, including HIPAA concerns.
• Assist in gathering preliminary information and coordinating with relevant departments to ensure timely escalation and resolution.
• Contribute to risk mitigation planning and ensure alignment with regulatory expectations and internal protocols.

Training & Education

• Develop and deliver training on regulatory requirements and compliance policies.
• Promote a culture of compliance and continuous improvement.

Regulatory Reporting & Documentation

• Prepare and submit required reports to oversight agencies (e.g., DHCS, CMS) and contracted health plans, as applicable under delegated arrangements.
• Report to appropriate regulatory or law enforcement authorities when warranted by compliance investigations, HIPAA breaches, or other reportable incidents.

Maintain documentation of regulatory communications, filings, and approvals

SUPERVISORY RESPONSIBILITIES

• Provide guidance and oversight to compliance staff, as needed.
• May supervise direct reports and support performance management, workload distribution, and professional development.

MINIMUM QUALIFICATIONS

• Bachelor's degree in Healthcare Administration, Public Policy, Law, or a related field; OR an equivalent combination of education and progressively responsible experience in healthcare compliance or regulatory affairs.
• 3+ years of experience in healthcare compliance or regulatory affairs, preferably within a managed care organization, IPA, MSO, TPA, or other delegated entity.
• Strong understanding of California healthcare legislation, DHCS, DMHC, CMS, and NCQA requirements.
• Experience with regulatory monitoring, policy management, audit readiness, and delegation oversight.
• Prior experience managing or supervising staff, preferred.
• Excellent communication, analytical, and project management skills.

CERTIFICATES AND/OR LICENSES

• Certification required: Certified in Healthcare Compliance (CHC) or Certified in Healthcare Privacy Compliance (CHPC), issued by the Compliance Certification Board (CCB); or ability to obtain certification within 24 months of hire.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to an inside environment.

The Community Health Center Network is an Equal Opportunity Employer.