Director, Federal & Integrated Regulatory Strategy

MetroPlusHealth; New York (NY); Hybrid; USD 180,000 - 210,000; Full time

Job summary

MetroPlus Health in New York seeks a Director, Federal and Integrated Regulatory Guidance to guide Medicare Advantage and integrated product regulatory efforts. You will monitor CMS rules, translate guidance for business units, and shape implementation strategies while leading a small team.

Ideal candidates have 5+ years in Medicare/regulatory affairs within a managed care setting, strong communication skills, and the ability to manage multiple projects across departments.

Qualifications

• Bachelor’s degree required.
• 5 years’ experience with Medicare and Integrated products.
• 5 years’ experience in a compliance, regulatory affairs, or government affairs function within a Managed Care Organization.
• Knowledge of CMS rules and regulations as it relates to Medicare products and integrated/dual eligible plans.
• Understanding of managed care operations.

Responsibilities

• Track state and federal regulatory changes for dissemination to business leads in understandable terms, and develop implementation plans.
• Collaborate with cross-functional work groups to implement regulatory changes.
• Monitor proposed state and federal guidance and solicit input from impacted leaders.
• Advise sales and marketing on permissible activities for campaigns and collateral.
• Review and update policies and procedures to align with current regulatory standards.
• Track Medicare local coverage determinations to assist policy development.
• Inform senior leadership of potential compliance issues and delays in implementation.
• Provide feedback to direct reports on performance and progress toward goals.
• Engage with direct reports to identify career path goals and development needs.
• Other duties as assigned.

Skills

Regulatory guidance

Project management

Cross-functional collaboration

Excel

Word

PowerPoint

SharePoint

Education

Bachelor’s degree

Tools

SharePoint

MS Excel

MS Word

PowerPoint

Job description

Position Overview

Empower. Unite. Care.

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care 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.

The Director, Federal and Integrated Regulatory Guidance will oversee regulatory guidance for the Plan’s Medicare Advantage and Integrated Products. This involves daily monitoring of state and federal communications, analyzing guidance and translating into simple language for the respective impacted business areas. The Director will work to develop implementation strategies and specific operational activities to support timely and compliant implementation, while providing ongoing guidance and support throughout the life cycle of implementation projects. The Director will monitor proposed guidance, share changes and impact with leadership and solicit feedback as a means to contribute to state and federal policy development. The Director also advises the sales and marketing team as to permissible activities for marketing and outreach campaigns and related collateral. The Director will directly supervise a team of two.

Scope of Role & Responsibilities

• Track state and federal regulatory changes for purposes of disseminating information to business leads in easy to understand terminology, develop implementation approach and basic set of activities required to comply with regulatory change.
• Participate and collaborate with cross functional work groups established to implement regulatory changes.
• Monitor proposed state and federal guidance, solicit input from impacted business leaders.
• Advise sales and marketing team as to permissible activities for marketing and outreach campaigns and related collateral.
• Review and update Policies and Procedures to ensure content is aligned with current regulatory standards.
• Track Medicare local coverage determinations to assist in policy and procedure review and development.
• Inform Senior and Executive Staff of potential compliance issues, delays in implementing regulatory and/or policy changes.
• Provide feedback to direct reports on a regular basis as to performance, progress with meeting team goals.
• Engage with direct reports to identify team members’ goals for career path, areas for improvement.
• Other duties as assigned or requested.

Education, Training & Professional Experience

• Bachelor’s degree required
• 5 years’ experience with Medicare and Integrated (Duals) products
• 5 years’ experience in a compliance, regulatory affairs, or government affairs function within a Managed Care Organization.
• Knowledge of CMS rules and regulations as it relates to Medicare products and integrated/dual eligible plans
• Understanding of managed care operations
• Experience managing complicated projects, keeping track of details, and staging work to deliver projects on time
• Proven ability to articulate regulatory requirements to business and technical staff to capture information and achieve results

Licensure and/or Certification Preferred

• None

Professional Competencies

• Solid Microsoft Excel skills and strong proficiency using MS Word, Excel and PowerPoint and SharePoint.
• High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met. Simultaneously, manage multiple projects.
• Excellent oral, written, analytical and presentation skills required.
• Ability to interpret regulatory guidance and summarize guidance.
• Ability to multi-task various projects at the same time.
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary.

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