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Years of Experience
Date Last Verified
Manager, Regulatory Compliance Duties: Oversee and manage the State Regulatory Compliance Team to ensure state-based compliance matters are addressed and handled within the timelines specified by law, regulation, and/or management. Responsible for performance and oversight of regulatory compliance for state laws, at the direction of the VP RPC and as the VP’s primary back-up, with respect to the state related compliance issues which includes managing and overseeing all aspects of documentation for the state compliance program. Keeps the Compliance Officer/VP RPC informed of all state compliance issues, including legislative developments, for assigned responsibilities. Manages, and conducts as necessary, research and responses to compliance concerns raised by internal and external stakeholders regarding state laws impacting company business, policies and procedures, and accreditation standards. Ensures regulatory agency and contractual deadlines are met. Works with various departments and the state regulatory compliance team to provide information and direction with regard to all state-related regulatory agency and contractual requirements. Assist such departments in the resolution of issues. Supervises the functions of the state regulatory compliance team and audits work performed by such persons to ensure compliance with department standards, company policy, accreditation standards and state law. Such functions involve, monitoring new laws and regulations, communicating those developments in a timely manner to internal committees, maintaining regulatory filings and licenses, conducting regulatory research, and maintaining documentation in department files. Develops and monitors department standards in consultation with the Compliance Officer/VP RPC. Provides project management and training support to Compliance Officer/VP RPC in relation to corporate’s Compliance Office and compliance plan as needed. Demonstrates subject matter expertise on state regulatory enforcement expectations in a constantly evolving regulatory environment. Responsible for ensuring the maintenance, review and development of policy, procedures and forms related to department processes. Coordinates policy review with Policy Operations team to ensure timely review of company policies supporting state compliance. Supports and provides lead role in representing the department at Key Process Team, Workgroup and Corporate Compliance Committee meetings as directed by the Compliance Officer/VP RPC. Updates and completes, at the direction of the VP, RPC, annual and on-going compliance status reports and risk assessments for company operations. Reports results of assessments to the Compliance Officer/VP RPC and conducts follow up on findings as directed by the VP. Works with internal departments to complete assessments and identify and remedy compliance concerns. Performs all related duties, as assigned.
Qualification and Experience
Qualifications: A Bachelor’s degree in English or equivalent; A Law Degree helpful. 5-7 years of experience with maintaining managed care related licensures and monitoring related regulatory compliance in a health insurance environment. Prior experience managing staff and working with cross-functional areas helpful. Strong working knowledge of laws and regulations pertaining to managed health care and provider group administrative functions, including Utilization Review, Third Party Administration, downstream risk assumption and specialized physical medicine related health care services. Computer skills including word processing, Excel spreadsheets, Access and email. Detail orientated with the ability to effectively organize, prioritize, multi-task and manage time. Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships. Demonstrated ability to manage and lead a small team across multiple locations. Ability to display excellent customer service to meet the needs and expectations of both internal and external customers. Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment; and effective written communication skills. Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions. Demonstrated accuracy and productivity in a changing environment with constant interruptions. Ability to exercise strict confidentiality in all matters.
Requisition Number 14-0158 IN
Company infoHuman Resources Department