Home › Companies › Hdkk Fa Us6 Oraclecloud Com CX 2001 › Managed Care Compliance Specialist - Managed Care
Managed Care Compliance Specialist - Managed Care
Hdkk Fa Us6 Oraclecloud Com CX 2001 · CA, United States; CSMG - Wilshire, Beverly Hills, CA, US · Active · Oracle Recruiting Cloud / Fusion HCM
Job facts
| Field | Value |
|---|---|
| Company | Hdkk Fa Us6 Oraclecloud Com CX 2001 |
| Title | Managed Care Compliance Specialist - Managed Care |
| Normalized title | - |
| Department / team | CSMC 8714004 MNS Managed Care |
| Location | CA, United States |
| Work model | - |
| Employment type | - |
| Salary | - |
| Status | active |
| ATS provider | Oracle Recruiting Cloud / Fusion HCM |
| Posted / first seen | 2025-09-09 / 2026-05-31 |
| Changed / last seen | 2026-05-31 / 2026-06-06 |
Related slices
| Page | What it contains | Open |
|---|---|---|
| Company jobs | Active postings from Hdkk Fa Us6 Oraclecloud Com CX 2001. | Open |
| Company breakdowns | Role, location, ATS, and work model facets for this company. | Open |
| ATS provider jobs | Active postings observed through Oracle Recruiting Cloud / Fusion HCM. | Open |
| Provider filtered search | The same provider as a filtered job collection. | Open |
| Department jobs | Active postings in CSMC 8714004 MNS Managed Care. | Open |
| Lifecycle events | Open, update, close, and reopen events for this posting. | Open |
| Original posting | Canonical source or apply URL captured from the ATS. | Open |
Linked records
| Company | Hdkk Fa Us6 Oraclecloud Com CX 2001 |
| Source | 0cf6eada-2abe-405b-a726-303c9adf8347 |
| ATS provider | Oracle Recruiting Cloud / Fusion HCM |
Description
Description
The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.
Duties and Responsibilities:
Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.
Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.
Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.
Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.
Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.
Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.
Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.
Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.
Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.
Remains updated on all member and provider policy changes made by the health plan and/or the State.
Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.
Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.
Qualifications
Education: High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.
Experience: Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.
Organization
With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai’s medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.
Company
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.
Full job record
| Job ID | 3dbd4e068b1249ce0f83afa46761d85c8661dbab |
| Org ID | ba262c18-bc93-43ce-9b41-0e92a17bc240 |
| Source ID | 0cf6eada-2abe-405b-a726-303c9adf8347 |
| Board ID | 0cf6eada-2abe-405b-a726-303c9adf8347 |
| Provider | oracle_hcm |
| Provider Job Key | 11981 |
| Title | Managed Care Compliance Specialist - Managed Care |
| Normalized Title | — |
| Status | active |
| Active | yes |
| Location Text | CA, United States; CSMG - Wilshire, Beverly Hills, CA, US |
| Department | CSMC 8714004 MNS Managed Care |
| Team | — |
| Employment Type | — |
| Workplace Type | — |
| Remote Policy | — |
| Country | United States |
| Region | CA |
| City | — |
| Salary Raw | Description The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS. Duties and Responsibilities: Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements. Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care. Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care. Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care. Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met. Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding. Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits. Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises. Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. Remains updated on all member and provider policy changes made by the health plan and/or the State. Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices. Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements. Qualifications Education: High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred. Experience: Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred. Organization With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai’s medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond. Company Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents. |
| Salary Min | — |
| Salary Max | — |
| Salary Currency | — |
| Salary Period | — |
| Source URL | https://hdkk.fa.us6.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_2001/job/11981 |
| Apply URL | https://hdkk.fa.us6.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_2001/job/11981 |
| First Seen At | 2026-05-31 17:56:48Z |
| Last Seen At | 2026-06-06 19:06:32Z |
| Last Checked At | 2026-06-06 19:06:32Z |
| Last Changed At | 2026-05-31 17:56:48Z |
| Inactive At | — |
| Source Posted At | 2025-09-09 16:23:21Z |
| Source Updated At | — |
| Raw Payload Uri | s3://job-postings-prod-raw-590183727216/raw/provider=oracle_hcm/board=hdkk.fa.us6.oraclecloud.com|CX_2001/date=2026-06-06/2026-06-06T19-05-35-433Z-9588f25b1fd282830ae976623bc5a1f840a94c0624e6e3e5a014a99dfabfdee8.json |
Event Fields
{
"content_hash": "8fcf3a7324f725e1eefe04ddfc99c2e802236a81d2a5665a2c64c3fb3189a1e1",
"source_hash": "f16e7c483b895330fae73cf4e8dad32c2475dbbf8dee578439e921fa6ba80cdb",
"last_changed_at": "2026-05-31T17:56:48.262Z",
"active_status": "active"
}Parsed Structured
{
"language": "en",
"location": {
"raw": "CA, United States",
"city": null,
"region": "CA",
"country": "United States",
"is_remote": false,
"confidence": 0.8
},
"salary_max": null,
"salary_min": null,
"inferred_at": "2026-06-06T19:06:32.225Z",
"launch_scope": {
"reason": "english_us_canada",
"included": true,
"language": "en",
"location": {
"raw": "CA, United States",
"city": null,
"region": "CA",
"country": "United States",
"is_remote": false,
"confidence": 0.8
},
"countries": [
"United States"
]
},
"remote_policy": null,
"salary_period": null,
"workplace_type": null,
"salary_currency": null
}Extensions
{}Native Structured
{
"detail": {
"Id": "11981",
"Title": "Managed Care Compliance Specialist - Managed Care",
"media": [],
"skills": [],
"JobType": null,
"Category": "Strategic Plan / Business Dev",
"JobGrade": null,
"JobLevel": null,
"JobShift": null,
"WorkDays": null,
"WorkHours": null,
"WorkYears": null,
"Department": "CSMC 8714004 MNS Managed Care",
"HotJobFlag": false,
"StudyLevel": null,
"WorkMonths": null,
"WorkerType": null,
"GeographyId": 300000002391005,
"JobFamilyId": 300000011197830,
"JobFunction": "Managed Care",
"JobSchedule": null,
"BusinessUnit": null,
"ContractType": null,
"Organization": null,
"TrendingFlag": true,
"workLocation": [
{
"Country": "US",
"Region1": "Los Angeles",
"Region2": "CA",
"Region3": null,
"Building": null,
"Latitude": "34.06722",
"Longitude": "-118.38253",
"LocationId": 300000011196977,
"PostalCode": "90211",
"TownOrCity": "Beverly Hills",
"AddressLine1": "8501 Wilshire Blvd",
"AddressLine2": null,
"AddressLine3": null,
"AddressLine4": null,
"LocationName": "CSMG - Wilshire"
}
],
"ContentLocale": "en",
"HiringManager": null,
"LegalEmployer": "Cedars-Sinai Medical Center",
"RequisitionId": 300000607762409,
"WorkplaceType": "",
"BusinessUnitId": 300000002341107,
"OrganizationId": 1,
"GeographyNodeId": 100000694291833,
"JobFunctionCode": "MNC",
"LegalEmployerId": 300000002358001,
"PrimaryLocation": "CA, United States",
"RequisitionType": "Professional",
"NumberOfOpenings": null,
"WorkplaceTypeCode": null,
"BeFirstToApplyFlag": false,
"otherWorkLocations": [],
"secondaryLocations": [],
"ExternalContactName": null,
"ShortDescriptionStr": "",
"ExternalContactEmail": null,
"ExternalPostedEndDate": null,
"OtherRequisitionTitle": null,
"requisitionFlexFields": [
{
"Value": "EXEMPT",
"Prompt": "Overtime Status",
"ControlType": "TextArea",
"SequenceNumber": 6
},
{
"Value": "1 Day",
"Prompt": "Primary Shift",
"ControlType": "SingleChoiceList",
"SequenceNumber": 7
},
{
"Value": "8 hour",
"Prompt": "Shift Duration",
"ControlType": "SingleChoiceList",
"SequenceNumber": 8
},
{
"Value": "34.69",
"Prompt": "Minimum Salary",
"ControlType": "TextArea",
"SequenceNumber": 14
},
{
"Value": "53.77",
"Prompt": "Maximum Salary",
"ControlType": "TextArea",
"SequenceNumber": 15
},
{
"Value": "Exempt",
"Prompt": "UKG Pay Rule",
"ControlType": "SingleChoiceList",
"SequenceNumber": 16
}
],
"ApplyWhenNotPostedFlag": true,
"DomesticTravelRequired": null,
"ExternalDescriptionStr": "<p>The Managed Care Compliance Specialist is responsible for assisting with the implementation of the internal auditing and monitoring program within the Managed Care department by ensuring compliance with applicable rules and regulations including but not limited to AB1455 and Medicare Claims Processing Guidelines. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHCS.</p>Duties and Responsibilities:\n<ul>\n <li>Ensures all services provided to Commercial, Medicare and Medi-cal managed care members are in compliance with program regulations, insurance regulations, and regulatory requirements.</li>\n <li>Maintains and tracks laws and regulations, contract documentations, amendments, and various compliance measures pertaining to Commercial, Medicare and Medi-cal managed care.</li>\n <li>Develops policies, procedures, and processes to align with federal program regulations and any applicable state regulations pertaining to Commercial, Medicare and Medi-Cal managed care.</li>\n <li>Provides mentorship to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language for Commercial, Medicare and Medi-Cal managed care.</li>\n <li>Acts as a liaison with health plans and current CSHS departments to ensure both health plan regulations and CSHS policies are met.</li>\n <li>Coordinates and act as primary contact for all health plans audits, including leading all aspects of the review for performance management and accurate coding.</li>\n <li>Develops and supervise compliance with corrective action plans as a result of post-health plan audits and regulatory audits.</li>\n <li>Provides required Compliance and FWA trainings for existing, new employees and non-employees, as the need arises.</li>\n <li>Educates CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc.</li>\n <li>Remains updated on all member and provider policy changes made by the health plan and/or the State.</li>\n <li>Acts as subject matter expert on health care laws/regulations as a compliance resource to CSHS and affiliates, including contracted and employed physician practices.</li>\n <li>Aggregates, analyze, and report audit results, identify error trends and root causes, and make recommendations for performance improvements.</li>\n</ul>",
"ObjectVerNumberProfile": null,
"PrimaryLocationCountry": "US",
"CorporateDescriptionStr": "Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars- Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow's health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.",
"ExternalPostedStartDate": "2025-09-09T16:23:21+00:00",
"ExternalQualificationsStr": "<h2>Education:</h2><p>High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.</p><h2>Experience:</h2><p>Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.</p>",
"InternalQualificationsStr": "<h2>Education:</h2><p>High school diploma/GED required. Bachelor's degree in Healthcare or related field preferred.</p><h2>Experience:</h2><p>Five (5) years of compliance experience, preferably in a healthcare environment, required. Two (2) years of Medi-Cal, Medicare or Commercial Managed Care experience preferred.</p>",
"OrganizationDescriptionStr": "With a growing number of primary urgent and specialty care locations across Southern California, Cedars-Sinai’s medical network serves people near where they live. Delivering coordinated, compassionate healthcare you can join our network of clinicians and physicians to improve the healthcare people throughout Los Angeles and beyond.",
"primaryLocationCoordinates": [
{
"Latitude": "37.2202",
"Longitude": "-119.4905",
"CountryCode": "US",
"GeographyId": 300000002391005,
"GeographyNodeId": 100000694291833
}
],
"ExternalResponsibilitiesStr": "",
"InternalResponsibilitiesStr": "",
"InternationalTravelRequired": null
},
"list_job": {
"Id": "11981",
"Title": "Managed Care Compliance Specialist - Managed Care",
"JobType": null,
"Distance": 1757376000000,
"JobShift": null,
"Language": "US",
"WorkDays": null,
"JobFamily": null,
"Relevancy": 2,
"WorkHours": null,
"Department": null,
"HotJobFlag": false,
"PostedDate": "2025-09-09",
"StudyLevel": null,
"WorkerType": null,
"GeographyId": 300000002391005,
"JobFunction": null,
"JobSchedule": null,
"BusinessUnit": null,
"ContractType": null,
"ManagerLevel": null,
"Organization": null,
"TrendingFlag": true,
"workLocation": [
{
"Country": "US",
"Region1": "Los Angeles",
"Region2": "CA",
"Region3": null,
"Building": null,
"Latitude": 34.06722,
"Longitude": -118.38253,
"LocationId": 300000011196977,
"PostalCode": "90211",
"TownOrCity": "Beverly Hills",
"AddressLine1": "8501 Wilshire Blvd",
"AddressLine2": null,
"AddressLine3": null,
"AddressLine4": null,
"LocationName": "CSMG - Wilshire"
}
],
"LegalEmployer": null,
"MediaThumbURL": null,
"WorkplaceType": "",
"BusinessUnitId": 300000002341107,
"OrganizationId": 1,
"PostingEndDate": null,
"LegalEmployerId": 300000002358001,
"PrimaryLocation": "CA, United States",
"WorkDurationYears": null,
"WorkplaceTypeCode": null,
"BeFirstToApplyFlag": false,
"WorkDurationMonths": null,
"otherWorkLocations": [],
"secondaryLocations": [],
"ShortDescriptionStr": "",
"requisitionFlexFields": [],
"DomesticTravelRequired": null,
"PrimaryLocationCountry": "US",
"ExternalQualificationsStr": null,
"ExternalResponsibilitiesStr": null,
"InternationalTravelRequired": null
},
"detail_meta": {
"url": "https://hdkk.fa.us6.oraclecloud.com/hcmRestApi/resources/latest/recruitingCEJobRequisitionDetails?expand=all&onlyData=true&finder=ById;Id=%2211981%22,siteNumber=CX_2001",
"http_status": 200,
"content_type": "application/json",
"response_bytes": 8197
},
"detail_errors": []
}Get this page with API
Rendered from the bluedoor Job Postings API. Reproduce it:
GET https://api.bluedoor.sh/job-postings/v1/jobs/3dbd4e068b1249ce0f83afa46761d85c8661dbab?include=descriptionJSONGET https://api.bluedoor.sh/job-postings/v1/orgs/ba262c18-bc93-43ce-9b41-0e92a17bc240JSONGET https://api.bluedoor.sh/job-postings/v1/sources/0cf6eada-2abe-405b-a726-303c9adf8347JSONGET https://api.bluedoor.sh/job-postings/v1/jobs/3dbd4e068b1249ce0f83afa46761d85c8661dbab/eventsJSON