MetroPlusHealth · 3 hours ago
Director of State Product Compliance
United States
Full-time
Remote
Mid, Senior Level
5+ years expMetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. The Director of State Product Compliance plays an integral role in overseeing and managing product regulatory compliance activities for State products, ensuring adherence to regulatory requirements and supporting corrective actions.
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
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
Preferred
CHC, CCEP
Benefits
Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
Retirement Savings and Pension Plans
Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
Loan Forgiveness Programs for eligible employees
College tuition discounts and professional development opportunities
College Savings Program
Union Benefits for eligible titles
Multiple employee discounts programs
Commuter Benefits Programs
Company
MetroPlusHealth
MetroPlusHealth provides health insurance to individuals, families, and small businesses.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Julie Myers
Deputy Chief Medical Officer
Laura Santella-Saccone
Chief Marketing & Brand Officer
Recent News
2025-07-17
Company data provided by crunchbase