Under guidance from the CC Manager of Regulatory Performance, the Clinical Advisor is
responsible for drafting, editing, reviewing, auditing, tracking, monitoring and maintaining
policies and procedures for Partnership HealthPlan of California. Alongside designated
organizational leadership ensures compliance with governing rules, regulations, and/or
accreditation standards. Reviews both draft and final All Plan Letters (APLs) and/or regulatory
changes and supports leaders with the research, planning, implementation and/or operational
readiness submissions across the organization.
The Clinical Advisor may support new and ongoing training and staff support needs within the
Care Coordination department through the translation of regulatory requirements to operational
training, and assist the Care Coordination leadership team on necessary audits and projects.

▪ Performs policy research to analyze current and/or new regulations by applicable
Partnership regulators and/or accrediting agencies (ex: DHCS, DMHC, CMS, NCQA,
etc.).
▪ Reviews timely draft and/or final All Plan Letters (APL), Policy Guides and/or other
DHCS guidance for policy impact.
▪ Proactively identifies policies impacted by regulatory changes.
▪ In collaboration with stakeholders throughout the organization, drafts and prepares new
policies.
▪ In collaboration with the CC Regulatory Performance Manager and Quality & Training
Supervisor develops training program courses and materials in accordance with Partnership
policies & procedures.
▪ Provides mentorship, direction, resources, training and/or orientation to clinical Care
Coordination staff; maintaining and active working knowledge of all departmental
policies/procedures.
▪ Creates effective training materials including but not limited to desktops, flyers, FAQs,
informational emails, newsletters, etc.
▪ Assess existing training materials and other offerings and recommends changes to meet
departmental objectives and Partnership policies & procedures.
▪ Assist in reviewing and maintaining up-to-date knowledge NCQA regulations concerning
care coordination activities and programs.
▪ Supports clinical file review for internal and external NCQA to ensure program goals,
quality standards and department metrics are met.
▪ Supports departmental NCQA auditing and tracking activities.

▪ Assist in maintaining departmental library of required NCQA documents and reports for
auditing purposes.
▪ Prepares all policies and/or related materials for appropriate committees’ review and/or
submission to associated regulatory or accrediting agencies.
▪ Supports Partnership audit and compliance readiness by submitting all materials timely.
▪ Serves as PowerDMS ‘Super User’ in the organization to effectively route policies with
multi-departmental impacts to appropriate reviewers.
▪ Participates in audits with Partnership’s regulatory and/or accreditation bodies by
preparing policies, documents and/or reports as needed.
▪ Communicates and coordinates across the organization to ensure that all active and current
Partnership policies are available and reflected on Partnership websites.
▪ Conducts analysis, collect information, and evaluates the impact of regulatory and
compliance issues to inform auditing and monitoring activities.
▪ Analyzes the impact of new programs/benefits and efficacy of existing processes, policies,
procedures and trainings.
▪ Consults with department leadership on a wide variety of compliance related subject matter
areas as it relates to policies and procedures.
▪ Attends all major committee meetings as policy and procedure advisor and key consultant
on policy and procedure matters.
▪ Works collaboratively with care coordination leadership to identify and implement
strategies to improve quality and compliance.
▪ Other duties as assigned.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$56.98 - $74.07

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.