JOB SUMMARY
 This position will be specifically assigned to Interfaith’s California Advancing and Innovating Medi-Cal (CalAIM) Community Support Services program and is responsible for ensuring compliance with all Federal, State, and County regulations related to the operation of the CalAIM and Medi-Cal, including Medi-Cal Managed Care Plans (MCPs). This position will monitor and evaluate overall program effectiveness, quality and compliance, and performs related work as required supporting the mission of Interfaith Community Services.

ESSENTIAL DUTIES AND RESPONSIBILITIES 

To perform this job successfully, an individual must be able to perform each essential duty 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 the essential functions.

The following duties and responsibilities are those considered to be essential but do not represent all job functions that may be required to be performed by this position. Other comparable duties and responsibilities may be assigned as needed.

• Assists management in ensuring compliance with all Federal, State, and County regulations and initiatives including, but not limited to, the State of California CalAIM Initiatives, Medi-Cal, Health Insurance Portability and Accountability Act (HIPAA), and 42 CFR Part 2;
• Provides technical assistance and training related to CalAIM Community Support Services;
• Assists leadership in maintaining and renewing all contracts and certifications;
• Leads and performs complex professional-analytical work pertaining to the review and analysis of departmental operations, policies, and procedures, which may include ad hoc analyses of various statistical and fiscal data; 
• Manages the development, maintenance, and revision of policies, procedures, and practices for the general compliance and operations of CalAIM, as directed.
• Assists in the preparation of and monitoring of contracts and agreements with outside service providers as needed;
• Tracks outcomes and performance, using the Electronic Health Record system to support ongoing outcomes monitoring;
• Reviews program updates, letters, and notices for potential impact on programs and activities; recommends and prepares policy and procedure changes to ensure compliance; 
• Serves as an administrator/super user for the Agency’s Electronic Health Record system;
• Carries out functions of the Agency Quality Assurance and Compliance Plan within the CalAIM Community Supports program and supports the development and improvement of policies and procedures related to compliance and quality assurance;
• Performs internal program audits/Quality Assurance Reviews for CalAIM program, on a regular basis;
• Tests internal systems of controls and monitoring to ensure that all aspects of the program (including but not limited to personnel files, billing, and fiscal data, and programming) are in compliance with contracts and regulations and maintains the highest standards of care;
• Conducts, develops, and implements periodic internal evaluations utilizing quantitative data to assess the effectiveness of CalAIM;
• Assists in the development of internal Quality Improvement Plans and Continuous Quality Improvement;
• Provides results of internal assessments to be presented in communications materials and reports;
• Maintains contract files and policies and procedures in an efficient, organized manner;
• Performs analysis of data, including trends in program performance, client demographics, and needs assessments;
• Helps to ensure that Interfaith is fully prepared for audits and quality assurance reviews.
• Serves as the primary liaison with the Medi-Cal Managed Care Plans to coordinate Grievance & Appeals;
• Participates in staff meetings and trainings; and
• Performs additional duties as assigned by supervisor.

EDUCATION/YEARS EXPERIENCE

• Bachelor’s Degree in Healthcare Administration, Public Administration, or related field required.
• One (1) or more years of experience in auditing and/or quality assurance, working in highly regulated program compliance, or closely related field-required. 
• Any combination of educational and work experience that would be equivalent to the stated minimum requirements .
• Experience with Electronic Health Records preferred.
• Experience with Medi-Cal, Medi-Cal Managed Care, and/or CalAIM preferred.

EMPLOYMENT BENEFITS

• Paid Time Off – Three weeks to start!
• Paid Holidays – 13 scheduled
• Flexible Work Schedules
• Medical, Dental, and Vision Insurance
• AD&D / Group Life Insurance
• Flexible Spending Accounts – Medical and Dependent Care
• Matched 401(k) Retirement Plan
• Early Release Days!
• Work Anniversary Bonuses
• Tuition Reimbursement and Public Service Loan Forgiveness Eligibility
• Employee Assistance Plan (EAP)
• Home Ownership Assistance Program
• Casual Work Environment
• Professional Growth and Career Development Opportunities

Interfaith is an equal opportunity employer. Qualified applicants will be considered without regard to age, race, creed, color, national origin, ancestry, religion, pregnancy, marital status, affectional or sexual orientation, gender identity or expression, genetic information, disability, nationality, sex, veteran status, or any other characteristic protected by federal, state or local law. In addition, Interfaith will provide reasonable accommodations for qualified individuals with disabilities.