Regulatory Compliance Operations Director

4 weeks ago

New York, New York, United States MetroPlusHealth Full time
Job Title: Director of Regulatory Compliance Operations

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us.

About the Role

As Director of Regulatory Compliance Operations, you will oversee our regulatory approval, regulatory submission, and policies and procedures processes. This role is responsible for ensuring communications and submissions to regulatory agencies are in compliance with applicable requirements for all lines of business.

Key Responsibilities
  • Contribute to the annual Plan risk assessment, collaborating with the various Compliance teams, to assist the enterprise in identifying areas with potential compliance issues.
  • Oversee the Regulatory Compliance Operations unit and their management of regulatory and material submissions and the Policy and Procedure Program.
  • Prepare and update materials for compliance committees including the Compliance Committee and Audit and Compliance Committee of the Board of Directors.
  • Serve as the regulatory expert to ensure that marketing practices are consistent with regulatory guidelines.
  • Serve as the liaison and manage correspondence with regulators regarding Plan submissions (member communications, marketing, reports, etc.), including complex regulatory questions and submissions for advisory comment.
  • Propose creative, effective, and compliant regulatory strategies and solutions to challenging concepts that meet business objectives and minimize regulatory risk.
  • Provide regulatory consultation in the development and implementation of marketing strategy and promotional programs.
  • Provide regulatory input on concepts and draft materials to help ensure materials are aligned with regulations.
  • Maintain current awareness of evolving regulations and interpretations, advisory letters, enforcement letters and policy issues impacting managed care organizations.
  • Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives.
  • Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance.
  • Ability to take on complex projects and provide regulatory training and coaching to team members.
Requirements
  • Bachelor's Degree required, Masters in Health Care or Communications preferred.
  • Minimum five years of experience working in managed care compliance or regulatory department and must possess detailed knowledge of the rules governing managed care health plans.
  • 2-3 years of experience managing staff, including demonstrated ability to coach and mentor.
  • Experience with NY State managed care products strongly preferred.
  • 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.
  • Experience building relationships across business groups internally and outside the organization.

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