Regulatory Operations Manager - Health Plan Compliance

phsorg; United States; On-site; USD 76,000 - 129,000; Full time

Benefits offered by this job

Medical, dental, vision

Short-term & long-term disability

Life insurance

Employee Wellness program

Job summary

Presbyterian Health Plan (PHP) is seeking a Regulatory Operations Manager to lead regulatory activities for commercial, Medicaid and Medicare Advantage lines. You will identify and implement regulatory changes, coordinate agency inquiries, and perform complex analyses to help business owners meet state and federal requirements.

Interaction with PHP staff and regulators is essential. The role requires a Bachelor's degree and 3–5 years in health plan management/regulatory/compliance, with strong

Qualifications

• Bachelor's degree required.
• 3–5 years experience in health plan management and regulatory/compliance.
• Experience with health insurance regulation preferred.
• Ability to influence others and manage multiple activities simultaneously.

Responsibilities

• Lead regulatory operations in alignment with PHP leadership and Legal Counsel.
• Respond to regulatory inquiries, audits, and reporting requirements for insurance products.
• Track and interpret federal/state laws and regulatory changes impacting PHP products.
• Translate laws into practical policies and guidelines for business areas.
• Support CAP elements and compliance monitoring activities across departments.
• Participate in regulatory liaison activities with various stakeholders.

Skills

Regulatory compliance

Health plan management

Regulatory/legal experience

Ability to manage multiple activities

Education

Bachelor's Degree

Job description

Presbyterian Health Plan (PHP) is seeking a Regulatory Operations Manager to lead regulatory activities for commercial, Medicaid and Medicare Advantage lines. You will identify and implement regulatory changes, coordinate agency inquiries, and perform complex analyses to help business owners meet state and federal requirements.

Interaction with PHP staff and regulators is essential. The role requires a Bachelor's degree and 3–5 years in health plan management/regulatory/compliance, with strong