Sr Regulatory Mgr LTC Products

Description and Requirements

The Senior Regulatory Manager, LTC Products will serve as the primary lead for maintaining, ensuring and fostering an environment that enhances and promotes compliance, adherence to corporation's ethical standards and conformance to all relevant federal, state and local laws, rules and regulations applicable to the company's State and Federal contracts for Healthfirst's Long Term Care product offerings.

Duties/Responsibilities: Researches, interprets and clearly and thoroughly communicates regulatory requirements and new legislation that impact the business, as well as recommends and/or facilitates with stakeholders the required steps to effectuate necessary changes. Identifies potential risk areas and develops or facilitates corrective actions with stakeholders to ensure continuing compliance. Serves as a point of contact with regulatory agencies, including but not limited to the Centers for Medicare & Medicaid Services, the New York State Department of Health, New York Department of Financial Services, Office of Medicaid Inspector General, and others. In collaboration with the Healthfirst Compliance department, oversees the implementation and effectuation of all plans of correction developed for both internal and external audits. Acts as a consultant to internal departments regarding regulatory issues while understanding the underlying root cause and applicable regulatory requirements, conducts analysis of risk, and recommends or initiates necessary corrective action. Works in conjunction with stakeholders to ensure newly enacted requirements are implemented within mandated time frames. Reviews and approves policies and procedures to ensure regulatory requirements are met. Responsible for preparation and presentation at various internal meetings including but not limited to the Regulatory Affairs monthly briefing, Complaints Tracking Monitoring (CTM) workgroup, etc. Responsible for coordinating, gathering, reviewing and submitting all MLTC and FIDA reporting Coordinates all required Federal and State attestations with the appropriate persons, prepares and collects sub certifications as appropriate to ensure that deadlines are met. Responsible for bringing pertinent items to the Healthfirst Core Workgroup and seeing projects through to fruition to ensure all associated deadlines are met. Reviews and approves all marketing materials and internal training documents to ensure compliance with Federal/State requirements and oversees the submission and communication of federal and/or state approvals for these materials. Works in collaboration with Regulatory Audit Managers on all external agency audits/site visits pertinent to LTC plans Minimum Qualifications: Bachelor's degree in a related field (e.g., political science, health sciences, economics, health policy, public health, natural sciences, public policy), OR at least 5 years working in a regulatory/compliance capacity for a health plan Experience interpreting and summarizing federal and state health insurance laws and regulations Familiarity with and knowledge of Managed Long Term Care plans, Medicare Advantage plans, Medicare Dual Eligible Special Needs Plans Experience interacting with the Centers for Medicare & Medicaid Services (DMS) and New York State Dept. of Health (SDOH) regulatory entities Preferred Qualifications: Excellent written and verbal communication skills Demonstrated ability to communicate clearly, succinctly and effectively Ability to summarize complex materials/concepts/ideas in a clear and concise manner Excellent analytical, editing, organizational and presentation skills