Commercial Regulatory Guidance Specialist

MetroPlus Health Plan; New York (NY); On-site; USD 90,000 - 100,000; Full time

Job summary

An established industry player is seeking a Commercial Regulatory Guidance Specialist to oversee compliance across various commercial lines. This pivotal role involves monitoring regulatory changes, updating policies, and collaborating with teams to ensure adherence to state regulations. The ideal candidate will possess strong analytical and communication skills, with a solid background in Regulatory Affairs. Join a mission-driven organization dedicated to empowering communities and making healthcare accessible to all. If you thrive in a dynamic environment and are passionate about regulatory compliance, this opportunity is perfect for you.

Qualifications

• 5+ years of experience in Regulatory Affairs with a focus on compliance.
• Bachelor's degree required; Master's preferred.

Responsibilities

• Monitor and assess new State regulatory guidance for compliance.
• Collaborate with teams to implement regulatory changes.

Skills

Regulatory Affairs

Project Management

Analytical Skills

Communication Skills

Education

Bachelor's Degree

Master's Degree

Tools

MS Word

MS Excel

SharePoint

PowerPoint

Job description

Commercial Regulatory Guidance Specialist

Job Ref : 119331

Category : Compliance and Regulatory

Department : OFFICE CORPORATE COMPLIANCE

Location : 50 Water Street, 7th Floor,

New York, NY 10004

Job Type : Regular

Employment Type : Full-Time

Salary Range : $90,000.00 - $100,000.00

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides high-quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 providers and clinics. For over 30 years, MetroPlus has been dedicated to building strong relationships with members and providers to enable healthier lives.

Position Overview

Empower. Unite. Care.

MetroPlusHealth seeks a Commercial Regulatory Guidance Specialist to oversee and manage product regulatory activities across our commercial lines, including the Essential Plan, Quality Health Plans, and Large Group products. Reporting to the Director of State Regulatory Guidance, this role ensures compliance with NY State Department of Health and Department of Financial Services regulations.

Job Responsibilities

1. Monitor, interpret, distribute, track, and assess new State regulatory guidance, including memos, directives, and documents related to commercial compliance.
2. Update departmental policies to reflect contract changes by monitoring government and healthcare websites and communications for new or amended regulations.
3. Review and interpret regulatory guidance, analyze impacts, and coordinate implementation with business units to ensure compliance.
4. Support best practices in business areas such as Enrollment, Marketing, Retention, Customer Experience, and Claims by applying regulatory knowledge.
5. Collaborate with Product and PMO teams to develop project plans for regulatory changes affecting the commercial lines of business.
6. Provide guidance and clarification on regulatory issues to internal teams.
7. Participate in coalition calls and workgroups, document minutes, and share insights with relevant departments.
8. Conduct research on regulatory questions and assist with audits, surveys, and reporting activities.
9. Support additional regulatory activities as needed, ensuring ongoing knowledge of State Sponsored products.
10. Assist in managing projects impacting multiple business areas to ensure proper regulatory implementation.

Minimum Qualifications

• Bachelor's degree required.
• At least 5 years of Regulatory Affairs experience.
• Proficiency in MS Word, Excel, SharePoint, and PowerPoint.
• Experience requiring independent judgment and initiative.
• Ability to meet deadlines, multitask, problem-solve, and utilize technology effectively. Project management skills are a plus.
• Master's degree preferred.
• Experience with State Exchange products is strongly preferred.