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Regulatory Strategy

3 months ago

Honolulu, United States Kaiser Permanente Full time

Develop, manage and implement regulatory strategy to maintain existing product lines or support entry into new markets upon creation of new products. Responsible for the direction and ensuring regulatory compliance with government requirements and KPIC''s (or similar department''s) contractual obligations in support of the Department''s goals and the organization''s mission/vision. Develop guidance for adherence of KPIC''s (or similar department''s) contractual requirements; synchronize with industry standard and other high risk areas. Establishes a strong program for effective partnership with regulatory bodies; national& regional operations; national and regional product development areas; rating and actuarial divisions and national and regional sales and marketing department''s. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. Researches current and upcoming federal and state regulatory guidelines, laws and statutes; compliance issues and recommends changes and/or analyzes impacts to assure compliance with contract obligations. Acts as point of contact and liaison for all Regulatory Agency audits providing logistical coordination, schedules, requested reports and information and acts as departmental representative in communicating and interfacing within KPIC; with KP''s compliance areas and outside agencies on regulatory issues. Ensures all relevant external regulatory requirements are identified and develops processes to disseminate information on regulatory compliance requirements to appropriate personnel. Engage external regulatory and legislative bodies on developing regulations, passage of laws in support of the organization''s strategic direction. Plan oversight on regulatory filings and monitoring operation functions such as benefit management and Plan Operations such as enrollment, premium billing, member service, etc, claims processing, and quality improvement.Essential Functions:Direct reports are usually supervisors/ managers, or senior level professional/technical employees.- Reports to Director or Executive Director.- Purview is department or may be multiple units.- Change Agent.- Ensures the day to day operation and management of assigned regulatory services, in accordance with contract, all applicable regulatory requirements and laws, and policies and procedures.- Manages implements, participates and may lead in the development of regulatory strategy to maintain existing product lines or support entry into new markets upon creation of new products.- May set up strategic direction of regulatory team to interface and support all regulatory requirements of the company with the appropriate external organizations.- May work directly with regulatory agencies on complex and unique regulatory issues and submissions.- Measures and monitors the execution of department and processes.- Initiates and evaluates required business process improvements in order to achieve business results and appropriate solutions for customers.- Manages financial aspects of the department; accountable for direct budget.- Manages HR/People processes for the department including performance reviews/management, resource management, planning, objective setting/alignment, employee development/coaching and training.Basic Qualifications:Experience Minimum six (6) years of management experience in health care/insurance regulatory compliance environment with two (2) years of management regulatory operations, compliance and or quality improvement experience required.Education Bachelor''s degree in related area.License, Certification, Registration N/AAdditional Requirements: Requires thorough working knowledge of government regulations agencies particularly that of various state''s Department of Insurance and/or other agencies such as CMS, (Medicaid) DMHC, (Department of Managed Health Care); Department of Labor (ERISA);DHS (Department of Health Services MediCal) affecting compliance activities required for health care administration; and thorough knowledge on HIPAA issues and requirements. Demonstrated ability in performing thorough investigations, developing logical conclusions and effective analytical reports. Must be able to work in a Labor/Management Partnership environment.Preferred Qualifications: Paralegal or law degree preferred.Notes: Candidate w/strong insurance industry knowledge (specific to traditional insurance products - not HMO); expertise with stop-loss and level funding. COMPANY: KAISERTITLE: Regulatory Strategy & Contracts Senior ManagerLOCATION: Honolulu, HawaiiREQNUMBER: 1076511External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.