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MetroPlusHealth · 1 week ago

Director of State Product Compliance

United States

Full-time

Remote

Mid, Senior Level

$150K/yr - $170K/yr

5+ years exp

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. The Director of State Product Compliance will oversee and manage product regulatory compliance activities for various state products, ensuring adherence to regulatory requirements and supporting corrective actions as needed.

Financial ServicesHealth CareHealth InsuranceInsuranceLife Insurance

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

Ensures open lines of communication, both internally and externally, so any reports of potential noncompliance are received and investigated

Assisting in the identification and resolution of noncompliance issues. Upon identification, will provide support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance review. If self-disclosure is required, will compile and prepare necessary information

Assist business areas in creating and updating monitoring metrics to assess continued compliance with regulatory requirements

Serves as a voting member of the Delegation Oversight Subcommittee; providing Compliance advisement and ensuring all delegate related non-compliance issues/trends are reported. Participates in auditing and monitoring functions of downstream entities

Other duties as assigned or requested

Qualification

Regulatory complianceManaged care operationsLeadership experienceHealth care administrationQuality improvementAuditingNYS DOH regulationsTrustIntegrityCustomer FocusProblem solvingInterpersonal skillsAttention to detailCommunication skills

Required

Bachelor's Degree required, Masters in Health Care or JD preferred

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

Integrity and Trust

Customer Focus

Functional/Technical skills

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

Ability to make independent decisions with Plan department leaders, external vendors, regulators, and accreditation bodies

Exceptional and creative troubleshooting skills with a keen ability to expediently analyze situations and implement process improvements and effective solutions

Proficient in understanding and speaking the English language, with strong written communication verbal in person and telephonically and presentation skills

Demonstrates ability to manage conflict, build, support, mentor teams and the ability to recognize and address positive behaviors that contribute to successful achievement of Plan goals