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Senior Director of Regulatory Affairs

MetroPlus

New York (NY)

Remote

USD 90,000 - 160,000

Full time

30+ days ago

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Job summary

An established industry player is seeking a Senior Director of Regulatory Affairs to lead a team dedicated to navigating complex healthcare regulations. In this pivotal role, you will ensure compliance with Medicare and Medicaid laws while fostering collaboration across departments. The position offers the opportunity to influence strategic decisions and drive improvements in regulatory processes, all while working primarily in a remote capacity. If you are a strategic thinker with a passion for healthcare and a commitment to excellence, this role promises to be both rewarding and impactful.

Qualifications

  • 10+ years of experience with Medicare and Medicaid regulations.
  • Strong knowledge of health law and compliance programs.
  • Ability to manage and direct regulatory affairs personnel.

Responsibilities

  • Lead the Regulatory Affairs unit and ensure compliance with new regulations.
  • Provide regulatory support and communication across the organization.
  • Manage workflows for timely resolution of regulatory complaints.

Skills

Medicare laws and regulations
Medicaid laws and regulations
Health law and policy
Compliance programs
Strategic thinking
Communication skills
Project management
Relationship building

Education

Bachelor's degree

Tools

Legal research applications (e.g., Lexis)

Job description

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's network includes over 27,000 primary care providers, specialists, and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

As a Senior Director of Regulatory Affairs, 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 Senior Director of Regulatory Affairs is responsible for providing leadership and oversight of the Regulatory Affairs unit relating to all products offered by MetroPlusHealth, as well as leading other projects assigned by Executive Leadership.
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 laws (state and federal) across the MetroPlusHealth portfolio of businesses.
  • Direct and supervise the Regulatory Affairs unit to ensure that all new regulations and product contract updates 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.
  • Lead continuous improvement of communication processes to better inform the enterprise of new legislation and regulatory agency directives.
  • Assist the Compliance teams with understanding of Federal, State, and Local regulations and product contract requirements.
  • Establish protocols and guidelines for oversight of implementations of new rules/requirements, including carve-ins of services and populations to various insurance products.
  • Develop and advise on comprehensive and actionable communications and content informing of regulatory analysis, changes, and impact, to facilitate stronger front-end compliance consistent with regulations.
  • Partner with Compliance team on management of and response to external audits and surveys relating to NY State product offerings, including NYS Department of Health Article 44 program audits.
  • Participate in engagement with Local, State, and Federal agencies, and Trade Associations.
  • Oversee and manage workflows to ensure timely and appropriate resolution of Regulatory Complaints and Fair Hearings.
  • Serve as leadership interface with internal departments (including sales, operations, product, pharmacy, communications, government affairs, legal) and external clients relating to regulatory matters.
  • 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.
  • Drive team success, engagement, and development to resolve highly complex or unusual business problems.
Minimum Qualifications
  • Bachelor's degree required.
  • Minimum ten 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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