Regulatory Operations Leader — Health Plan Compliance

0200 Fluent Health LLC; United States; Sur place; USD 76 000 - 129 000; Plein temps

Avantages offerts par ce poste

Medical, dental, vision benefits

Short-term and long-term disability

Wellness rewards program

Résumé du poste

Presbyterian Healthcare Services seeks a Regulatory Operations Manager to lead the Regulatory Operations department and oversee insurance product regulatory activities across commercial, Medicaid, and Medicare Advantage lines.

The role involves coordinating regulatory responses, researching and interpreting regulations, and collaborating with legal, compliance, and business teams to minimize risk and ensure compliant practices across PHP's health plans.

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.

Responsabilités

• Works closely with leadership and regulatory staff to ensure compliance with contractual and regulatory requirements.
• Supports regulatory inquiries, reporting requirements, and audits; collects materials and facilitates site visits.
• Tracks federal and state laws, regulations, and new legislation related to PHP insurance products.
• Presents key changes and major initiatives at internal meetings.
• Translates laws and regulations for implementation by stakeholders.
• Provides analysis and recommendations on program standards under Legal Counsel guidance.
• Assists in monitoring compliance and minimizing PHP risk through collaboration across departments.
• Assists with CAP elements and compliance program activities as needed.
• Maintains audit preparedness tools and participates in compliance team meetings.

Connaissances

Regulatory knowledge

Compliance experience

Health plan understanding

Formation

Bachelor's degree

Description du poste

Presbyterian Healthcare Services seeks a Regulatory Operations Manager to lead the Regulatory Operations department and oversee insurance product regulatory activities across commercial, Medicaid, and Medicare Advantage lines.

The role involves coordinating regulatory responses, researching and interpreting regulations, and collaborating with legal, compliance, and business teams to minimize risk and ensure compliant practices across PHP's health plans.