Manager, Medicare Compliance & Regulatory Affairs

VNS Health; New York (NY); Híbrido; USD 110 000 - 147 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Referral bonuses

PTO and holidays

Health insurance

Retirement matching

Wellness programs

FSAs for healthcare and dependent care

Tuition reimbursement

Career growth opportunities

Internal mobility and CEU credits

Resumo da oferta

VNS Health, a long-standing New York health service provider, seeks a Manager of Compliance and Regulatory Affairs. You will lead regulatory projects, guide operational teams on compliance, and manage filings and CAPs to ensure adherence to CMS and NYS rules.

The role emphasizes collaboration across departments, risk assessment, and training on new requirements, with on-site NY presence three days weekly.

Qualificações

• Bachelor’s degree in business, health care administration, or related field required.
• Master’s degree preferred.
• Minimum four years in health care with compliance/regulatory affairs and leadership experience.

Responsabilidades

• Lead regulatory affairs projects and liaison with business areas to implement changes.
• Provide guidance on compliance risks and communicate high-impact regulatory changes.
• Manage regulatory filings, CAPs, attestation reports, and corrective actions.
• Assist in developing and maintaining compliance policies and procedures.
• Prepare updates for management, Board, and Compliance Committee.
• Monitor federal and NYS regulations affecting managed care and MAPD plans.
• Develop auditing and monitoring processes for compliance implementation.
• Coordinate with CMS account managers on disclosures and inquiries.

Conhecimentos

Regulatory leadership

Regulatory affairs

Project management

Communication skills

MS Office

Formação académica

Bachelor's degree in business, Health Care Administration, or related discipline

Master's degree preferred

Ferramentas

Word

Excel

PowerPoint

Descrição da oferta de emprego

Overview

Oversees compliance and regulatory functions to ensure VNS Health's managed care products are in accordance with applicable federal and New York State laws, regulations, and contractual requirements. Serves as a subject matter expert in managed care regulations, collaborates with internal departments to promote a strong culture of compliance, and liaises with applicable state and federal agencies on regulatory matters. The Manager has a deep understanding of healthcare compliance, regulatory frameworks, and risk management and possesses strong leadership and interpersonal skills, with the ability to influence and guide cross-functional teams. This individual works under general supervision. Assigned portfolio includes VNS Health's Medicare Advantage products (i.e., MA-PD, D-SNP, FIDE SNP), with an emphasis on federal Medicare requirements. Serves as the subject matter expert in Medicare Compliance regulations, liaises with CMS on regulatory matters, and has a deep understanding of Medicare compliance, including Program Audit experience.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

This role requires an on-site presence in New York three days per week

What You Will Do

• Serves as Project Manager for regulatory affairs projects related to new or updated regulatory guidance. Acts as the liaison with business areas to ensure appropriate changes are made to the impacted departments. Develops monitoring processes to ensure implementation is effective and compliant.
• Provides guidance to lines of business on compliance risks, ensuring operational readiness and adherence. Ensures that communications regarding high-impact regulatory changes are provided to key operational and shared services stakeholders. Develops and provides training and education on new or updated regulatory requirements to Compliance and operations, as applicable.
• Manages regulatory filings, submissions, and reporting obligations, including oversight of corrective action plans (CAPs), routine compliance reports, and required attestations. Manages the process for the issuance, development, remediation, and validation of regulator-issued CAPs for identified and/or reported issues of non-compliance.
• Assists in the review, development, revision and maintenance of compliance policies and procedures.
• Assists in the preparation of updates and reports to management, Board of Directors, and Compliance Committee related to regulatory affairs and related compliance activities.
• Ensures compliance with requirements established by applicable federal and state regulatory bodies and other bodies overseeing managed care organizations.
• Monitors and interprets applicable federal and New York State statutes, regulations, and guidance affecting managed care organizations. Assesses the impact of applicable regulatory changes on the enterprise's programs and health insurance plans.
• Develops and maintains tracking related to external audits, corrective action plans, attestations, etc.
• Assists with the annual risk assessment and development of the auditing and monitoring plan.
• Ensures compliance with requirements established by the Centers for Medicare & Medicaid Services (CMS).
• Monitors and interprets applicable federal regulations and guidance affecting MAPD plans. Assesses the impact of Federal regulatory changes on the enterprise's programs and health insurance plans.
• For compliance and regulatory affairs projects, develops auditing and monitoring processes to ensure implementation is effective and compliant.
• Communicates with the Plan's CMS account manager regarding disclosures and general inquiries.

Qualifications

Licenses and Certifications

Compliance related certification preferred

Education

Bachelor's degree in business, Health Care Administration, or a related discipline required

Master's Degree preferred

Work Experience

• Minimum of four years of experience working in the health care industry, preferably with healthcare compliance, regulatory affairs, or managed care operations, with at least 3 years in a leadership or management role Required
• Demonstrated ability to research and interpret complex managed care regulations and communicate requirements effectively to operational teams Required
• Proven capacity to work collaboratively across departments and build strong compliance partnerships Required
• Exceptional ability organizational, analytical, time management, project management and problem-solving skills Required
• Excellent written and verbal communication skills Required
• Fluent in Word, Excel, and Power Point Strong knowledge of Medicare regulations and compliance requirements Required

Pay Range

USD $109,900.00 - USD $146,500.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.