Job Details

Deputy Director Of Regulatory Affairs

Company name

Metroplus Health Plan

Organization Type

Public Interest

Job Type

Attorney

Date Last Verified

May 21, 2020

Valid Through

Sep 03, 2020

Posted on

Dec 21, 2019

Salary

USD 95000 Annually

Years of Experience

3-5 yrs required

Location

New York City, NY, United States

Employment Type

Full-time

Industry

Legal
Practice Area
Government and Government Relations >> Government and Government Relations
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Profile

Deputy Director of Regulatory Affairs
Duties: Act as Plan’s fair hearing representative and sole liaison with OTDA /attorneys associated with cases (over 500 cases per year). Draft responses to post-hearing compliance orders. Assist with resolution of DFS and DOH complaints. Respond to complaints from the AG’s office (as needed). Act as Plan records custodian for all medical record requests and subpoenas (law firms, courts, regulatory agencies). Identify issues and obtain relevant guidance documents and information on new regulatory requirements. Draft guidance memos for dissemination (as needed). Conduct legal research and provide interpretive assistance to all lines of business. Conduct legal research in response to ad hoc requests/questions for all lines of business. Coordinate and prepare documents for regulatory submission. Conduct legal review of medical charts and plan policies and procedures in preparation for audits/surveys. Conduct preliminary audits and reviews of vendor documentation in preparation for audits/surveys. Serve as point person for review of legal adequacy of plan notices to members. Ensure timely implementation of member notification templates. Ensure timely State approval of plan policies and procedures. Liaise with State representatives when changes needed. Liaise with different business units during development of new products/implementation of new benefits to assess business needs and ensure compliance with all applicable regulations and reporting requirements. Compile data and convene plan staff in preparation for State and Federal audits and surveys. Prepare plans of corrections in response to statements of deficiencies for post-audit submission to regulatory agencies. Participate in various workgroups to ensure that plan complies with all State and Federal requirements. Participate in various workgroups on the implementation of new initiatives and/or to implement new processes for business units. Encounter Data Workgroup. Children’s Health & Behavioral Health Initiative. Fair Hearing Workgroup. Liaison between Member Services and ICAN – Independent Consumer Advocacy Network on review of complaint; providing guidance; review of documentation.. Participate in high level discussions regarding State initiated complaints.. Develop training curriculum for implementation of services authorization and appeal provisions of the Mega Rule - 42 CFR 438 (new model notices). Supervision of Legal Research Analyst. Supervision of Summer Interns. Assisting in preparing regulatory/compliance reporting to the Audit & Compliance Committee.

Qualification and Experience

Qualifications: Law Degree Required. 3-5 years of experience in Managed Care. Proficient in Microsoft Word, Excel, Powerpoint, Sharepoint.

Additional info

Job Ref: 51462

Company info

Hiring Coordinator
Metroplus Health Plan
160 Water Street
New York City, NY 10038

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