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 OverviewAs 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.
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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