Regulatory Production Specialist II

2 weeks ago

Rancho Cucamonga California, United States Inland Empire Health Plan Full time
Overview:
What you can expect 

 

Find joy in serving others with IEHP We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience

 

The Regulatory Production Specialist II will be responsible for managing day-to-day operations of a portfolio of regulatory member communication projects and providing support for ongoing regulatory communication campaigns. This role will be responsible for ensuring program activities are completed at a high quality and in a timely manner while ensuring compliance with all regulatory guidelines and timelines. The Regulatory Production Specialist II will be responsible for the coordination and completion of submissions to Federal and State regulatory agencies including DMHC, DHCS, and CMS. In particular, the Specialists’ portfolio will encompass all regulatory member materials for all LOBs including Medi-Cal, CMC, and the future DSNP product – to include the Provider Directory, Formulary, and Member Handbook.

 

Key Responsibilities:

 

1. Provide regulatory member communication activities coordination and advancement, including but not limited to, development of regulatory member materials, compliance monitoring and reporting, managing, and preparing submissions of regulatory member communication to federal and state agencies, and printer vendor management.
2. Develop regulatory materials for all LOBs including the Member Handbook (EOC), Provider Directory, and Formulary.
3. Partner in the development and implementation of regulatory communication strategies, processes, including design and development changes, to ensure timely completion of member materials in compliance with applicable regulations and standards.
4. Ensure compliance of regulatory member communication, including but not limited to, the provider directory, formulary, and member handbook, with all marketing guidelines and regulatory policies. 
5. Act as the liaison between the enterprise and translation vendors to ensure completion of translations for all regulatory member materials for all lines of business.
6. Work across the enterprise to facilitate the intent of regulations and policies and provide such recommendation to Marketing & Communications project teams and management.
7. Collaborate with internal and external partners to collaborate and synergize actions and processes to ensure standard work and standard reporting requirements and opportunities for improvement.
8. Monitor and coordinate the completion of regulatory Member mailings including the validation of insertion sequencing and mailing quantities.
9. Work with print vendors to ensure that proof of delivery statements are received timely for all regulatory projects and accurately maintain regulatory compliance records.
10. Organize the RFQ for annual and new member regulatory project bids for all lines of business and process in the financial system Oracle.
11. Perform regulatory submission assessments to validate completion of approval or renewal status. 
12. Adhere to the quality assurance standards of all regulatory materials including following strict regulatory requirements and standard of work.
13. Any other duties as required ensuring Health Plan operations are successful.

 

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Additional Benefits:
Perks

 

IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

 

CalPERS retirement

457(b) option with a contribution match

Generous paid time off- vacation, holidays, sick

State of the art fitness center on-site

Medical Insurance with Dental and Vision

Paid life insurance for employees with additional options

Short-term, and long-term disability options

Pet care insurance

Flexible Spending Account – Health Care/Childcare

Wellness programs that promote a healthy work-life balance

Career advancement opportunities and professional development

Competitive salary with annual merit increase

Team bonus opportunities

Qualifications:
Education & Experience

Minimum of five (5) years in Medi-Cal and/or Medicare managed care with regulatory marketing, enrollment, and member communications guidelines. Five (5) years of experience in a managed care environment with experience in managing complex projects, workplans and project management tools.

Bachelor's degree from an accredited institution required. In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above. 

Key Qualifications

Thorough knowledge of Medi-Cal and/or Medicare managed care in terms of regulatory Marketing, Enrollment, and Member Communications guidelines.

Understanding of and sensitivity to a multi-cultural environment and community.

Must have strong project managements skills.

Excellent writing, interpersonal, communications skills.

Must have a high degree of patience and attention to detail.

Demonstrate problem solving capabilities to resolve concerns that arise unexpectedly.

 

 

Start your journey towards a thriving future with IEHP and apply TODAY

 

Pay Range:
USD $34.41 - USD $44.73 /Hr.

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