MetroPlusHealth is looking for a Director of State Product Compliance to oversee and manage product regulatory compliance activities for State products, ensuring adherence to all related regulatory guidance and implementations, and supporting the organization with corrective actions and regulatory disclosures.
Requirements
- 5-8 years of experience in managed care operations, health care administration or quality improvement with direct oversight and leadership experience in auditing, delegation oversight, regulatory requirements specifically NYS DOH.
- Proven leadership as evidenced by 3-5 years of experience in leading and directing teams with divergent experience and goals from different departments, including managing multiple projects with various priorities and deadlines.
- Ability to use software to produce required documentation and reports.
- CHC, CCEP
Responsibilities
- Oversees a team of regulatory compliance specialists for State products offered by MetroPlusHealth.
- Contributes to the annual Plan risk assessment, collaborating with the various Compliance teams, to assist the enterprise in identifying areas with potential compliance issues.
- Supports the completion and presentation of the Annual Compliance Work Plan and oversees completion of auditing and monitoring projects assigned to the State Product Compliance Department.
- Developing, implementing and revising policies and procedures for the Product Compliance Department.
- Responsible for the day-to-day operations of the State Product Compliance Department.
- Preparing and updating materials for compliance committees including the Vendor Delegation Oversight Subcommittee, Compliance Committee, and Audit and Compliance Committee of the Board of Directors.
- Provide implementation oversight by ensuring regulatory requirements have been effectively implemented by the internal and external business areas for Medicaid, HIV SNP, HARP, CHP, EP, QHP, and Large Group.
Other
- Bachelor's Degree required, Masters in Health Care or JD preferred.
- Integrity and Trust
- Customer Focus
- Outstanding interpersonal and human relations skills; ability to organize and lead work teams, establish and maintain strong positive working relationships.
- Strong problem solving, analytical, negotiating, and independent decision-making skills paired with strong attention to detail.
