Regulatory Operations Lead - Health Plan Compliance

Presbyterian Healthcare Services; Albuquerque (NM); On-site; USD 76,000 - 129,000; Full time

Job summary

Presbyterian Healthcare Services in Albuquerque, NM seeks a Regulatory Operations Manager to lead the regulatory operations team and ensure compliant administration of health plan products including commercial, Medicaid, and Medicare Advantage. Responsibilities cover regulatory research, coordinating agency inquiries, and implementing new regulations across PHP’s insurance products.

The role involves collaborating with legal, compliance, and business units to minimize risk and ensure adherence

Qualifications

• Bachelor's degree required.
• Three to five years experience in health plan management and regulatory/legal or compliance.
• Specific experience with health insurance regulation preferred.
• Demonstrated ability through education and experience to manage compliance with laws and regulations.
• Can orchestrate multiple activities simultaneously to accomplish a goal, and use resources effectively and efficiently.
• Able to influence others without direct reporting relationship.

Responsibilities

• Work with leadership to ensure compliance with contractual and regulatory requirements.
• Support regulatory inquiries, reporting requirements, audits, and site visits.
• Track federal and state laws, regulations, and new legislation; present changes.
• Translate laws and contractual obligations for departmental teams.
• Provide analysis and recommendations on program standards under Legal Counsel guidance.
• Assist with monitoring CAP elements and compliance initiatives.
• Assist with compliance program activities, staff training, and investigations.
• Maintain tools for audit preparedness.
• Participate in legal and compliance team meetings.

Skills

Regulatory compliance

Policy interpretation

Cross-functional collaboration

Regulatory liaison

Education

Bachelor's degree

Job description

Presbyterian Healthcare Services in Albuquerque, NM seeks a Regulatory Operations Manager to lead the regulatory operations team and ensure compliant administration of health plan products including commercial, Medicaid, and Medicare Advantage. Responsibilities cover regulatory research, coordinating agency inquiries, and implementing new regulations across PHP’s insurance products.

The role involves collaborating with legal, compliance, and business units to minimize risk and ensure adherence