Regulatory Guidance Manager

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 network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Regulatory Guidance Manager is responsible for overseeing a team of analysts and ensuring regulatory compliance by disseminating guidance to affected business units. The position will develop and maintain relationships with regulatory agencies and stay up to date on any changes or updates to regulations. The position is accountable for supporting the Director of State Regulatory Guidance and will provide, as well as oversee, the provision of guidance to staff and for conducting regulatory research and analysis to identify and interpret regulatory requirements and trends. The position will be responsible for overseeing a team of analysts with expertise in different lines of business to ensure optimal performance of the department.

• Oversee a team of regulatory analysts to ensure timely dissemination of accurate guidance for applicable laws and regulations related to all NYS regulated Lines of Business (LOBs) that the Plan offers.
• Develop and coordinate with the Project Management Team (PMO) and the Product Team on workplans to implement new regulatory changes.
• Provide guidance and conduct regulatory research and analysis to help identify and interpret requirements and trends.
• Evaluate the impact of regulatory changes on the organization and advise plan leadership on necessary actions.
• Develop and maintain relationships with regulatory agencies and stay up-to-date on any changes or updates to regulations.
• Participate in stakeholder calls and create summaries of calls for dissemination to senior staff.
• Work with the Regulatory Operations team to manage the preparation and submission of regulatory filings, reports, and documentation.
• Identify and assess potential regulatory risks and develop strategies to mitigate those risks.
• Collaborate with cross-functional teams to ensure compliance across all areas of the organization.
• Participate in high-level implementations of carve-in/carve-out services; program services such as changing vendors or adding new vendors.
• Participate in various external audits/surveys such as the Article-44 Operational Survey to ensure compliance with state regulations. Upload all requested information into the Health Commerce System (HCS), the state's database, as necessary.
• Supervise a team of Regulatory Specialists assigning tasks and projects and conducting performance evaluations. Ensure that the team is adequately trained and equipped to perform their duties, including identifying and addressing knowledge and skill gaps and that staff are up to date with work assignments and provide guidance as needed. Provide feedback to staff to help improve their productivity, efficienciesand growth.
• Other duties as assigned by the Director, Senior Director or Chief Compliance & Regulatory Officer.

• Bachelor's degree required; and
• 5+ years of Regulatory Affairs work experience; or
• A satisfactory equivalent combination of education, training, and experience in other Managed Care operational departments.
• Experience with managing and leading teams.
• Master's degree or Juris Doctorate preferred.
• Experience with NY State managed care products strongly preferred.
• Strong knowledge of healthcare laws and regulations, including HIPPA, Medicare and Medicaid.
• Proficient MS Word, Excel, SharePoint and PowerPoint required.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Excellent analytical, problem-solving, and decision-making skills
• Excellent communications and interpersonal skills, with the ability to effectively communicate complex regulatory requirements to departmental staff at all levels
• Ability to prioritize and manage multiple tasks in a fast-paced environment
• Strong attention to detail and accuracy
• Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems
• Project management skills a plus

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