Care Delivery and Clinical Oversight Compliance, Program Manager

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The Program Manager is a member of the Health Plan Corporate Compliance department and is responsible for overseeing and monitoring the clinical quality and regulatory compliance performance of the organization's wholly owned care delivery assets. The role serves as the primary liaison between Corporate Compliance, the medical groups' leadership, and other enterprise functions (e.g., Quality, Operations, Network, Risk Adjustment) to ensure alignment with Medicare Advantage, Medicaid, and state regulatory requirements, as applicable. This position drives the design, implementation, and continuous improvement of a structured oversight program that proactively identifies, mitigates, and reports compliance and quality risks.

You Will
Serve as a compliance partner to the health plan's care delivery assets, offering clear, practical
guidance tailored to each care delivery assets' operations, including PACE. Key Responsibilities
include:

Oversight Program Design and Governance: * Develop and maintain a comprehensive oversight
framework for the care delivery assets that covers regulatory compliance, clinical quality, patient
safety, and operational performance. * Define and maintain policies, procedures, and standards for
delegated oversight, including charters, escalation pathways, and governance routines (e.g., joint
oversight committees, workgroups, and reporting cadence). * Collaborate with Legal, Quality,
Operations, and Network Management to ensure oversight requirements are incorporated into
medical group service agreements, operating models, and SLAs.

Monitoring, Auditing, and Reporting: * Develop and execute an annual risk-based monitoring and
audit plan for the medical groups, focusing on areas such as utilization management, access and
availability, care coordination, documentation and coding integrity, grievances and appeals, patient
safety, and adherence to clinical guidelines. * Establish performance dashboards and key
performance indicators (KPIs) for regulatory compliance and clinical quality, and ensure timely,
accurate reporting to Corporate Compliance leadership, the Compliance Committee, and relevant
Board committees. * Track findings, corrective actions, and timelines; work with care delivery
assets' leadership to ensure effective root cause analysis, sustainable remediation, and ongoing
monitoring. * Coordinate readiness and documentation for internal and external audits/assessments
related to the care delivery assets (e.g., CMS program audits, state surveys, accreditation reviews,
OIG or other regulatory inquiries).

Regulatory and Clinical Quality Expertise: * Maintain current knowledge of applicable federal and
state regulations and sub regulatory guidance (e.g., Medicare Advantage rules, CMS manuals,
NCQA standards, state Department of Insurance/Department of Managed Health Care
requirements, HIPAA, fraud/waste/abuse requirements). * Partner with Clinical Quality and Medical
Management to align oversight activities with HEDIS/Stars, patient safety initiatives, and clinical
quality improvement projects. * Provide interpretation and practical implementation guidance to care
delivery assets' leaders on new or changing regulatory and accreditation requirements.

Stakeholder Engagement and Relationship Management: * Serve as the primary corporate point of
contact for care delivery assets on compliance and clinical quality oversight matters. * Facilitate
regular joint meetings to review performance, discuss risks and issues, and agree on action plans. *
Support culture building efforts to reinforce accountability, transparency, and a strong "tone at the
middle" within the care delivery assets.

Issue Management and Corrective Action: * Coordinate intake, triage, and investigation of potential
compliance or quality issues arising from the care delivery assets, ensuring appropriate
documentation, escalation, and remediation. * Work with care delivery assets and health plan
leaders to design and implement corrective action plans, including specific metrics, owners, and
timelines. * Monitor effectiveness of corrective actions; adjust oversight intensity based on risk level
and demonstrated performance.

Project and Change Management: * Lead cross functional initiatives that impact both the health
plan and care delivery assets (e.g., new regulatory requirements, model of care changes, benefit
design changes affecting care delivery, AI/technology implementations touching clinical workflows).
* Apply structured project management methodologies to ensure clear scope, stakeholder
alignment, risk mitigation, and timely delivery. * Develop and manage project plans, status reports,
and communications tailored to executive, operational, and clinical audiences.

Training and Education: * Identify compliance and clinical quality training needs across the care
delivery assets and coordinate the development and delivery of targeted education (e.g.,
documentation and coding, UM decision making, grievance/appeal handling, documentation of
medical necessity, fraud/waste/abuse awareness). * Evaluate the effectiveness of training and
adjust content or delivery methods based on outcomes and feedback.

Reinforce an organizational culture of compliance, quality, and ethical conduct.

We seek Rebels who are curious about AI and its power to transform how we operate and serve
our members.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your Qualifications

• Bachelor's Degree in healthcare administration, nursing, health policy, public health, or related field or equivalent experience
• 5+ years of experience in healthcare compliance, medical group operations, quality, or related field.
• In-depth knowledge of Medi-Cal managed care requirements, DHCS contractual obligations, CMS, and PACE.
• Hands-on experience supporting or working within a medical group, IPA, FQHC, or delegated entity.
• Strong understanding of Medicare Advantage, FDR requirements, CMS regulations, audit processes, and corrective action management.
• Ability to translate complex regulatory standards into operational guidance appropriate for front-line medical group teams.

What's in it for you?
* Base Pay Range:$106,200 to $153,705 annually
* Work Mode: Mostly Onsite (In the Long Beach, CA office Tuesdays and Wednesdays)
* An annual employee bonus program
* Robust Wellness Program
* Generous paid-time-off (PTO) along with 11 paid holidays per year, 1 floating holiday, birthday off, and 2 volunteer days
* Excellent 401(k) Retirement Saving Plan with employer match
* Robust employee recognition program
* Tuition reimbursement
* An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)