Director of Regulatory Compliance Operations at MetroPlus

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 Overview

As Director, Regulatory Compliance Operations, you will oversee our regulatory approval, regulatory submission, and policies and procedures processes. This role is responsible for ensuring communications and submissions to regulatory agencies are in compliance with applicable requirements for all lines of business. 
 

• Contributes to the annual Plan risk assessment, collaborating with the various Compliance teams, to assist the enterprise in identifying areas with potential compliance issues.  
• Oversee the Regulatory Compliance Operations unit and their management of regulatory and material submissions and the Policy and Procedure Program. 
• Prepare and update materials for compliance committees including the Compliance Committee and Audit and Compliance Committee of the Board of Directors.
• Serve as the regulatory expert to ensure that marketing practices are consistent with regulatory guidelines. 
• Serve as the liaison and manage correspondence with regulators regarding Plan submissions (member communications, marketing, reports, etc.), including complex regulatory questions and submissions for advisory comment.
• Propose creative, effective, and compliant regulatory strategies and solutions to challenging concepts that meet business objectives and minimize regulatory risk
• Provide regulatory consultation in the development and implementation of marketing strategy and promotional programs
• Provide regulatory input on concepts and draft materials to help ensure materials are aligned with regulations
• Maintain current awareness of evolving regulations and interpretations, advisory letters, enforcement letters and policy issues impacting managed care organizations
• Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives. 
• Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance
• Ability to take on complex projects and provide regulatory training and coaching to team members
• Other activities as assigned by the Vice President of Compliance

• Bachelor's Degree required, Masters in Health Care or Communications preferred.
• Minimum five years of experience working in managed care compliance or regulatory department and must possess detailed knowledge of the rules governing managed care health plans.
• 2-3 years of experience managing staff, including demonstrated ability to coach and mentor.
• Experience with NY State managed care products strongly preferred. 
• 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.
• Experience building relationships across business groups internally and outside the organization.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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