Compliance and Regulatory Director-Remote

ZipRecruiter; New York (NY); Remote; USD 90,000 - 150,000; Full time

Job summary

An established industry player is seeking a Director of Federal & Integrated Regulatory Guidance to lead a team of regulatory professionals. This pivotal role involves analyzing complex regulations, ensuring compliance across various health plans, and fostering relationships with regulatory bodies. The ideal candidate will possess extensive experience in Medicare and Medicaid laws, along with exceptional leadership and communication skills. This remote position offers the flexibility to work from home while collaborating with key stakeholders as needed. If you're ready to make a significant impact in the regulatory landscape, this opportunity is perfect for you.

Qualifications

• 7+ years of experience in managed care compliance or regulatory department.
• Thorough knowledge of health law, policy, and managed care regulations.

Responsibilities

• Lead a team to analyze and interpret complex regulatory requirements.
• Support regulatory filings and ensure compliance across the organization.
• Develop relationships with regulatory agencies and communicate changes.

Skills

Medicare and Medicaid regulations

Regulatory compliance

Strategic thinking

Project management

Communication skills

Education

Bachelor's degree

Tools

Lexis

Job description

Job Description

Position Overview

As Director of Federal & Integrated Regulatory Guidance, you will manage a team of regulatory professionals who analyze new regulatory requirements, work closely with the business to understand the impact and obligations of those requirements, and support the business in understanding the evolving regulatory landscape. With wide latitude for individual initiative and decision making, the position is responsible for providing leadership and oversight relating to all Federal & Integrated products offered by client.

This role primarily operates remotely with in-office presence only as needed for key meetings, collaboration, or business needs.

Responsibilities

1. Provide leadership and expertise in analysis and interpretation of complex and voluminous enacted state laws across the client portfolio of Federal and Integrated products, including Managed Long-Term Care (MLTC), Medicaid Advantage Plus (MAP), Medicare Advantage, and Medicare D-SNP.
2. Direct and supervise the Regulatory guidance team to ensure dissemination of new regulations, product contract updates, and final rules throughout the organization.
3. Provide regulatory support, including interpretation and clarification from regulatory bodies.
4. Communicate proactively with internal divisions to stay informed about key regulatory issues.
5. Support communication processes to inform the enterprise of new legislation and directives.
6. Develop and maintain relationships with regulatory agencies and stay updated on regulation changes.
7. Participate in stakeholder calls and create summaries for senior staff.
8. Support preparation and submission of regulatory filings, reports, and documentation with the Regulatory Operations team.
9. Identify and assess regulatory risks and develop mitigation strategies.
10. Collaborate with cross-functional teams to ensure compliance.
11. Participate in high-level implementations like carve-in/carve-out services and vendor changes.
12. Assist Compliance teams with understanding regulations and contract requirements.
13. Partner on external audits and surveys, including CMS Program Audits.
14. Engage with Local and State agencies and Trade Associations.
15. Demonstrate strategic thinking to add value to business teams.
16. Coordinate with business leaders on regulatory changes to meet business goals and regulator expectations.
17. Anticipate regulatory trends and coordinate advocacy strategies with the government relations team.
18. Maintain collaborative relationships with regulators, clients, and partners.
19. Supervise Regulatory Analyst staff, assign tasks, and conduct performance evaluations.
20. Ensure team training, address knowledge gaps, and provide guidance.
21. Provide feedback to enhance staff productivity and growth.
22. Other duties as assigned by senior management.

Requirements

Minimum Qualifications

• Bachelor's degree
• At least 7 years of experience with Medicare and Medicaid laws/regulations, including senior roles in managed care compliance or regulatory departments, with detailed knowledge of managed care rules.
• Deep understanding of health law, policy, regulation, and healthcare standards.
• Knowledge of business and HR principles, management functions, and health plan operations.
• Ability to lead and supervise personnel.
• Experience building relationships internally and externally.

Professional Competencies

• Collaboration and strategic thinking
• Managing multiple projects effectively
• Excellent communication and presentation skills
• Integrity and confidentiality
• Experience with legal research tools like Lexis
• Ability to communicate complex information clearly in verbal and written form