Director, Regulatory and Managed Care Compliance, DentaQuest (California)

Sun Life U.S. is one of the largest providers of employee and government benefits helping approximately 50 million Americans access the care and coverage they need. Through employers industry partners and government programs Sun Life U.S. offers a portfolio of benefits and services including dental vision disability absence management life supplemental health medical stop-loss insurance and healthcare navigation. We have more than 6400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers partners and communities.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based cost-effective solutions are designed for Medicaid and CHIP Medicare Advantage small and large businesses and individuals. With a focus on prevention and value we aim to make quality care accessible to improve the oral health of all.

Location: Must reside in California

The Opportunity:

The Director Regulatory and Managed Care Compliance reporting to the AVP California Dental Operations will provide a broad range of compliance services in support of the overall enterprise and will lead compliance initiatives within their respective business division and region.

How you will contribute:

• Develop and maintain key relationships with the regulatory agencies including but not limited to the California Department of Managed Health Care (DMHC) and Coordinated Care Organizations (CCOs) in their respective business division and region.
• Ensure compliance with all state regulatory and CCO audits in their respective business division and region.
• Coordinate corporate attendance and participate in all regular compliance and quality management meetings required in the Western Region.
• Ensure timely and accurate reporting and audit responses to all regulatory agencies and CCOs.
• Assume lead role in all tasks associated with compliance related matters.
• Direct and conduct investigations of potential compliance issues and development and implementation of any necessary corrective action plan.
• Direct and enforce all compliance policies and procedures and consistent application of sanctions for failure to comply.
• Monitor research federal and state regulations and proposed regulations to determine applicability for the organization and/or business division and region and develop and execute strategies and proposed improvements or changes to current state.
• Develop implement and conduct periodic privacy risk assessments and related monitoring activities in coordination with Internal Audit and Compliance Program monitoring activities.
• Assume lead role in development and implementation of Fraud Waste and Abuse deliverables including FWA prevention handbook annual prevention plan quarterly reporting and annual assessment.
• Other duties as needed or required.

What you will bring with you:

• BA or BS degree in related field required
• 5 years experience with Managed Care and/or CCO programs and compliance.
• Healthcare/dental management or administration or related field preferred
• Ability to assume a reasonable level of individual responsibility to handle multiple projects and responsibilities at the same time and to work collaboratively in a nonhierarchical department structure.
• Ability to building strong relationships with leadership industry partners and regulatory entities to maintain and further develop the Organizations strong culture of ethics and compliance at all levels in the organization
• Strong understanding of legal and regulatory knowledge and experience in operational implementation
• Demonstrated knowledge and understanding of emerging trends and regulatory requirements
• Detail-oriented individual with excellent analytical organizational problem-solving and interpersonal skills.
• Excellent interpersonal skills and demonstrated ability to work collaboratively on a team among diverse groups
• Exceptional written and verbal communication skills.
• Ability to develop and/or interpret complex regulatory requirements and the ability to communicate technical and complex concepts.
• Attends additional training as requested/deemed necessary

Salary: $132600 - 198900
At our company we are committed to pay transparency and equity. The salary range for this role is competitive nationwide and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills qualifications experience education and geographic addition to your base salary this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

Not ready to apply yet but want to stay in touch Join our talent community to stay connected until the time is right for you!

We are committed to fostering an inclusive environment where all employees feel they belong are supported and empowered to thrive. We are dedicated to building teams with varied experiences backgrounds perspectives and ideas that benefit our colleagues clients and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life we prioritize your well-being with comprehensive benefits including generous vacation and sick time market-leading paid family parental and adoption leave medical coverage company paid life and AD&D insurance disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match stock purchase options and an employer-funded retirement account. Enjoy a flexible inclusive and collaborative work environment that supports career growth. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes Top Places to Work for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans unless the accommodation would impose an undue hardship on the operation of our business. Please email to request an accommodation.

For applicants residing in California please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of applicable state and local laws including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability or status as a protected veteran.