Director of Federal & Integrated Regulatory Guidance

MetroPlus Health Plan; New York (NY); Hybrid; USD 150,000 - 160,000; 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 managing regulatory compliance for various health plans and ensuring the organization stays ahead of evolving regulations. The ideal candidate will have extensive experience in Medicare and Medicaid laws, exceptional communication skills, and a strategic mindset. Join a mission-driven organization committed to empowering communities and providing high-quality healthcare services. This position primarily operates remotely, offering flexibility while ensuring key in-office collaboration when necessary.

Qualifications

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

Responsibilities

• Manage regulatory guidance team and analyze new regulatory requirements.
• Support compliance across all areas of the organization.

Skills

Medicare and Medicaid laws/regulations

Health law and policy

Project management

Collaboration

Analytic skills

Communication skills

Education

Bachelor's degree

Tools

Legal research applications (e.g., Lexis)

Job description

Director of Federal & Integrated Regulatory Guidance

Job Ref: 118404

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

Hire In Rate: $150,000.00

Salary Range: $150,000.00 - $160,000.00

Empower. Unite. Care.

MetroPlusHealth is 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.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State 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 network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

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 MetroPlusHealth.

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

Job Description

• Provide leadership and expertise in analysis and interpretation of complex and voluminous enacted state laws across the MetroPlusHealth portfolio of Federal and Integrated products. These consist of Managed Long-Term Care (MLTC), Medicaid Advantage Plus (MAP), Medicare Advantage, and Medicare D-SNP.
• Direct and supervise the Regulatory guidance team to ensure that all new regulations and product contract updates, and final rules are disseminated throughout the organization.
• Provide regulatory support to the organization, including providing regulatory interpretation and gaining clarification from regulatory bodies.
• Proactively communicate with internal divisions to become and remain educated about key regulatory issues affecting these areas.
• Support continuous improvement of communication processes to better inform the enterprise of new legislation and regulatory agency directives.
• Develop and maintain relationships with regulatory agencies and stay up-to-date on any changes or updates to regulations.
• Participate in stakeholder calls and create summaries of calls for dissemination to senior staff.
• Work with the Regulatory Operations team to support the preparation and submission of regulatory filings, reports, and documentation.
• Identify and assess potential regulatory risks and develop strategies to mitigate those risks.
• Collaborate with cross-functional teams to ensure compliance across all areas of the organization.
• Participate in high-level implementations of carve-in/carve-out services; program services such as changing vendors or adding new vendors.
• Assist the Compliance teams with understanding of Federal, State and Local regulations and product contract requirements.
• Partner with Compliance team on management of and response to external audits and surveys, including CMS Program Audits.
• Participate in engagement with Local and State agencies and Trade Associations.
• Demonstrate strategic mindset to deliver value to business teams.
• Support and coordinate with business leaders on regulatory changes to drive achievement of business goals and clarity of regulator expectations.
• Anticipate policy and emerging regulatory trends and coordinate advocacy strategies with government relations team.
• Cultivate and maintain solid collaborative relationships with business clients, regulators and MetroPlusHealth business partners.
• Supervise a team of Regulatory Analyst staff assigning tasks and projects and conducting performance evaluations.
• Ensure that the team is adequately trained and equipped to perform their duties, including identifying and addressing knowledge and skill gaps and that staff are up to date with work assignments and provide guidance as needed.
• Provide feedback to staff to help improve their productivity, efficiencies and growth.
• Other duties as assigned by the Senior Director of Regulatory Affairs or Chief Compliance & Regulatory Officer.

Minimum Qualifications

• Bachelor's degree
• Minimum seven (7) years of experience working with Medicare and Medicaid laws/regulations, including having held a senior position, in a managed care compliance or regulatory department and must possess detailed knowledge of the rules governing managed care health plans.
• Thorough knowledge in the application of health law and policy, managed regulation and compliance programs and/or the fundamentals of healthcare organization, administration and standards, regulations and law applicable to health plan operations.
• Knowledge of business and human resources administration principles, management functions, management processes and functions of health plan departments.
• Ability to direct and supervise personnel.
• Experience building relationships across business groups internally and outside the organization.

Professional Competencies

• Collaboration and Demonstrable strategic thinking ability
• Management of multiple projects simultaneously to own workload
• Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences.
• Integrity and Confidentiality
• Experience with legal research applications (such as Lexis).
• Ability to effectively understand and communicate detailed and complex information verbally and written with others. Solid verbal and written communication skills.
• Ability to excel at:
  • Communicating with Others
  • Managing Ambiguity and Uncertainty
  • Critical Thinking
  • Resilience and Resourcefulness
  • Influencing Others
  • Organizational Agility
  • Demonstrating Presence
  • Developing Others

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