Job Description
Department(s): Internal Audit, Office of Compliance
Reports to: Chief Compliance Officer
FLSA status: Exempt
Salary Grade: S - $154,000 - $270,512


About CalOptima Health

CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

About the Position

As a critical member of the CalOptima Health Office of Compliance leadership team, the Director for Internal Audit will be responsible for two primary areas of focus, Internal auditing and Regulatory Compliance auditing. The incumbent will interact with the CalOptima Health Board of Directors, executive leadership, department management, regulators and Legal Counsel.

Internal auditing: The incumbent will provide independent, objective assurance and consulting services designed to improve CalOptima Health's operations and internal controls over financial transactions and reporting, evaluating and improving the effectiveness of governance, risk management and control processes throughout the organization to enhance and protect organizational value. The incumbent will develop risk assessment and audit workplan within Committee of Sponsoring Organizations (COSO) or a similar framework. The incumbent will oversee and conduct independent performance audits of CalOptima Health's internal business operations, information systems, key initiatives/programs including grants and incentives, financial transactions with an emphasis on compliance with state/federal requirements, CalOptima Health policies, accreditation standards, internal controls and industry best practices, as it relates to CalOptima Health's programs. The incumbent will guide staff in the implementation of strategic and tactical direction to improve the efficiency and effectiveness of our internal processes and controls.

Regulatory Compliance auditing: The incumbent will audit CalOptima Health's operational areas for Regulatory Compliance with state and federal regulations, and in particular Medi-Cal managed care, and Medicare Advantage Prescription Drug Plan (MAPD) D-SNP regulations.


Duties & Responsibilities:

• Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Directs and assists the team in carrying out department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals/priorities for the department.

• Plans, develops and implements audit plans and other activities to ensure CalOptima Health's internal business areas are operating efficiently, effectively and within contractual, statutory and regulatory requirements.
• Conducts an evaluation of risk areas and an audit plan/schedule based on the risk assessment. This is effectively two key areas of focus - business process/information systems risk mitigation and Regulatory Compliance.
• Partners with the Chief Compliance Officer (CCO), Office of Compliance leaders and key CalOptima Health business leaders to effectively plan, organize and maintain an effective Enterprise Risk Management (ERM) function.
• Develops and executes an "annual internal controls and processes" audit plan of CalOptima Health's internal business areas in coordination with CalOptima Health's key business leaders particularly under the Chief Operating Officer (COO), Chief Financial Officer (CFO), Chief Information Officer/Chief Information Security Officer (CIO/CISO) and CCO; Develops and executes an annual Regulatory Compliance audit plan of CalOptima Health's internal business areas in coordination with CalOptima Health's Regulatory Affairs & Compliance department;
  • Ensures the annual internal controls and processes audit plan and Regulatory Compliance audit plan are executed, including the establishment of objectives and scope, the assignment of appropriate and adequately supervised resources, the documentation of work programs and testing results and the communication of results with applicable conclusions and recommendations to appropriate parties.
  • Manages critical business risks by communicating best practices, promoting process improvement and monitoring remediation activities.
  • Identifies benchmarking standards (leading practices) for identifying potential control gaps and/or opportunities for improving efficiency.
  • Ensures audit recommendations are practical and appropriate for managing risks identified during individual audit projects.
  • Obtains corrective action plans from appropriate CalOptima Health's business areas addressing these risks including actions to be taken, responsible parties and implementation due dates.
  • Performs the appropriate follow-up reviews to effectively monitor whether corrective action plan steps were properly implemented.
• Provides independent, objective assurance and consulting services designed to improve the organization's operations and internal controls over financial reporting, financial tracking of key initiatives, evaluating and improving the effectiveness of governance, risk management and control processes.
• Drives strategic thinking and decision making to ensure CalOptima Health's leadership is proactively addressing and anticipating issues; promotes appropriate risk management awareness and risk mitigation.
• Provides timely and accurate reporting on control gaps and status of remediation of audit findings; influences the strengthening of the control environment, governance processes and risk management practices through audit recommendations and validation of management's remediation action plans.
• Promotes and ensures the adoption of the use of data analytics in the Internal Audit function by collaborating with Finance and Information Technology Services to leverage and align with existing data analytics infrastructure and promotes a culture of data-driven audit findings and recommendations.
• Supports CalOptima Health in attracting, retaining and engaging a diverse and inclusive member-centric workforce that delivers on our purpose and reflects the communities in which we work, live and serve.
• Reviews and adjusts the Internal Audit plan, as necessary, in response to changes in CalOptima Health's business, risks, operations, programs, systems and controls and communicates those changes as needed.
• Ensures the Internal Audit team collectively possesses or obtains the knowledge, skills and other competencies needed to meet the requirements of the Internal Audit Charter.
• Completes other projects and duties as assigned.

Experience & Education:

• Bachelor's degree in Business Administration, Health Care Administration or related field required.
• 7 years of progressive experience in managing auditing, insurance, and operational processes and/or relevant auditing, accounting or finance role required.
• 3 years of management level experience, including direct supervision of staff in regulatory, financial audits, internal audit, and/or oversight for a large non-profit or government entity required.
• Experience in contracting, monitoring, and enforcing contract provisions required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Master's degree in Business Administration, Health Care Administration, Management Science/Operations Research or related field.
• Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Information Systems Auditor (CISA) or similar certification.
• 10 years of progressive experience in managing auditing, insurance, and operational processes and/or relevant auditing, accounting or finance role.
• 5 years executive experience which includes working relationships with senior members of management and significant experience making presentations to organizational boards and committees.
• Medicare/Medi-Cal managed care health plan experience.
  

Physical Demands and Work Environment:

The physical demands and work environment characteristics 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.

• Physical demands: While performing duties of the job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Employee must be able to communicate, particularly for regular phone use, in meetings and conducting presentations.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.

Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4280

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