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CareFirst BlueCross BlueShield · 3 days ago

Regulatory Policy Consultant (Remote)

United States

Full-time

Remote

Senior Level, Lead/Staff

$125K/yr - $223K/yr

10+ years exp

CareFirst BlueCross BlueShield is seeking a Regulatory Policy Consultant to provide strategic and tactical planning related to legislative and regulatory matters. The role involves analyzing legislation, ensuring compliance, and collaborating with various departments to improve operational processes and project outcomes.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Analyzes legislation and regulations as it relates to CareFirst and creates high level compliance requirements

Primary/dedicated Regulatory point of contact for Project Managers who implementation projects

Takes a lead role in various department and divisional projects, to ensure compliance with project compliance requirements, providing input on work team participants, identification of business needs and development of solutions, training, collaboration and communication

Present content, insights and guidance to Mandates and other CareFirst business areas, BCBSA and/or Blues Plans as needed for generating successful knowledge sharing and working relationships

Collaborate with other CareFirst Divisions/Departments and functional areas to help with identification of workflow opportunities driven by projects, operational changes and/or external regulations

Represent Mandates on Corporate and external facing workgroups, legislative, regulatory, and stakeholder bodies work groups, Americas Health Insurance Plans (AHIP), the Blue Cross and Blue Shield Association (BCBSA), as needed

Identify opportunities to create more robust processes surrounding new mandate projects to improve the throughput of the department, streamline operations, improve project outcomes and increase strategic alignment of technical delivery with business operations

Leverage strong business acumen to act as a subject matter expert on a variety of Mandate and cross departmental projects, adding strategic perspective to project and problem-solving efforts

Support internal and external policy decisions by providing management with analysis and recommendations on the operational impacts to CareFirst from external mandates

Support the efforts of the Mandates and ePMO team in the creation, quality assurance and refinement of Project Documentation and Status Reporting

Qualification

Healthcare operations experienceRegulatory compliance analysisProject managementPublic Health knowledgePublic Policy analysisBusiness process analysisAnalytical skillsInterpersonal skillsProblem-solving skillsCommunication skills

Required

Bachelor's Degree in Business, Finance or Technology fields

10 years' Healthcare operations and/or healthcare regulatory business background

Project management of healthcare related projects may be substituted for some of the years of business experience

Considerable judgment, tact, initiative, accuracy and integrity

Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests

Superior analytical skills and understanding of where to find information germane to mandates

Ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem

Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems

Self-motivated with a commitment to teamwork

Ability to recognize, analyze, and solve a variety of problems

Ability to convey information in a clear, concise, and logical manner

In-depth understanding of healthcare payor industry and operational processes and impacts of regulatory guidance

Effective written and interpersonal communication skills

Knowledge of state legislative and regulatory processes, public policy analysis

Understanding of insurance products and regulatory environment

Proven analytical and problem-solving skills to evaluate business processes and recommend effective solutions

Experience in project management, business process analysis, workflow, and task analysis

Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence

Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging

Preferred

Advance degree or Certificate in Public Health, Public Policy, Business, Finance or IT fields; or 15+ years progressive healthcare operations and/or healthcare regulatory experience

Experience and exposure to both IT and Business functions in a management position

Strong experience in connecting strategic imperatives to tactical project delivery, in collaboration with senior business and IT executives