Support PDF,DOC,DOCX,TXT,XLS,WPD,HTM,HTML fils up to 5MB
Years of Experience
Date Last Verified
Manager, Regulatory Compliance The candidate will 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. This includes keeping Compliance Officer/VP, Regulatory and Program Compliance (VP, RPC) and other senior management in the department apprised of state regulatory matters that will impact the company. 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. This 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, but are not limited to, 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 company'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. Update and complete, at the direction of the VP, RPC, annual and on-going compliance status reports and risk assessments for company operations. Report results of assessments to the Compliance Officer/VP RPC and conducts follow up on findings as directed by the VP. Work with internal departments to complete assessments and identify and remedy compliance concerns. Perform all related duties, as assigned.
Qualification and Experience
The candidate should have Bachelor's degree in English or equivalent. Paralegal Degree and/or Certificate or Law degree would be helpful. Must have 5-7 years of experience with maintaining managed care related licensures and monitor related regulatory compliance in a health insurance environment. Prior experience managing staff and working with cross-functional areas helpful. Should have 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.
Requisition Number: 14-0158 IN
Company infoHiring Coordinator