PACE Compliance Manager

at  Family Health Centers of San Diego

IMPACT LIVES, IMPACT COMMUNITY

Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in the country. With over 62 sites, over 227,000 patients, and over 417,000 visits last year, we provide a wide variety of health care and outreach services to a very diverse patient population. We are proud of our mission, our lasting community impact, and the cultural and individual diversity of our staff.
The Family Health Centers of San Diego (FHCSD) is currently seeking a Compliance Manager for our Program for All-Inclusive Care for the Elderly (PACE). The PACE Compliance Manager ensures compliance with all federal (Centers for Medicare and Medicaid Services [CMS]), state (Department of Health Care Services [DHCS]), and other applicable regulations for the FHCSD PACE program. This includes developing and maintaining a compliance program, performing risk assessments, audits, and ensuring regulatory submissions. The manager will coordinate compliance actions, train staff on regulatory standards, and proactively identify and mitigate risks.

REQUIREMENTS:

• Bachelor’s degree in business, healthcare, or a related field.
• 5 years’ experience in healthcare or clinical setting; PACE experience preferred.
• Strong organizational and time management skills.
• Knowledge of medical terminology, coding (Current Procedural Terminology [CPT], Healthcare Common Procedure Coding System [HCPCS], and International Classification of Diseases [ICD-10]), and compliance tools (Microsoft Excel, Word, etc.).
• Excellent verbal and written communication skills.
• Ability and means to travel between locations on an as needed basis.
• Requires an active California driver’s license for the class required for operation of assigned vehicle; DRIVER REQUIREMENTS: Age 21; Licensed for a minimum of 3 years; No violations and/or accidents within 3 years; No vehicle related suspensions/reinstatements; No DUI, reckless or felony Driving within 7 years.

RESPONSIBILITIES:

• Ensuring compliance with Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and other applicable regulations.
• Conducting compliance risk assessments and operational audits.
• Tracking and coordinating audit items and regulatory reports.
• Providing training to staff on policies and regulatory standards.
• Monitoring regulatory updates and implementing necessary changes.
• Identifying compliance risks and ensuring fiscal accountability.

KEY DUTIES:

• Monitor and assess regulatory updates from Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and other regulatory bodies.
• Evaluate the impact of regulatory changes on operations and finances.
• Conduct audits of claims, documentation, and processes.
• Perform regular risk assessments to identify compliance risks.
• Maintain a master calendar of compliance deadlines.
• Develop measures to prevent, detect, and correct fraud, waste, and abuse (FWA).
• Support audit preparation and manage survey/audit responses.
• Ensure documentation meets Centers for Medicare and Medicaid Services (CMS) and Department of Health Care Services (DHCS) standards and financial requirements.
• Prepare audit reports for leadership and address compliance deficiencies.