Government Programs Policy Specialist

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 Government Programs Policy Specialist conducts regulatory research and assists in the implementation of various government initiatives. The position also serves as a liaison for MetroPlusHealth and participates in various committees and workgroups to provide guidance to operational needs.

This role primarily operates remotely with in-office presence only as needed for key meetings, collaboration, or business needs.

• Monitor, distribute, interpret and analyze high volume of new laws, regulations and guidance applicable to specified business units.
• Track, monitor and assess pending legislation and regulations for potential impact to organization.
• Coordinate, collaborate and guide MetroPlusHealth departments with the implementation of impactful regulatory and legislative changes
• Complete timely research for regulatory questions on department processes, policies and procedures, or materials for applicable business units.
• Respond to requests for regulatory guidance - research, questions and provide clarification on new rules, regulations and/or administrative directives.
• Develop guidance for other departments on contract obligations by line of business.
• Support the regular development and review of Regulatory and Compliance policies and procedures for the general operation of the Plan's business.
• Contributes quality and timely data for the materials prepared for both the Internal Compliance Committee Meetings and Audit and Compliance Subcommittee of the Board of Directors.
• Develop workplans and monitor progress for any regulatory based requests.
• Other duties as assigned or requested.

• Bachelor's Degree required.
• 5 years of experience with demonstrated knowledge in researching, reviewing and interpreting laws and regulations.
• 3-5 years of Medicaid Managed Care or Managed Care Special Needs Plan experience.
• Prior successful experience working with regulators on compliance audits, reporting and other matters.
• Experience managing complicated projects, keeping track of details, and staging work to deliver projects on time.
• Proven ability to articulate regulatory requirements to business and technical staff to capture information and achieve results.
• Proficient in conducting research using LexisNexis, Westlaw, as well as Microsoft Word, Excel, PowerPoint, SharePoint.

Professional Competencies

• Project management skills, with ability to handle multiple projects and meet deadlines
• Process improvement skills
• Excellent written communication, research, and editing skills
• Ability to lead, influence, and build relationships with stakeholders across the organization
• Sound working knowledge in Word, Excel, PowerPoint, SharePoint, and Visio
• Knowledge in health care policies
• Creative problem-solving skills
• The utmost integrity in handling confidential materials

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