Manager, Regulatory Affairs (Hybrid) en Visiting Nurse Service of New York d/b/a VNS Health

Overview:Oversees compliance and regulatory functions to ensure VNS Health's managed Medicaid (i.e., mainstream, HIV SNP, Partial Cap/MLTC) and Medicare Advantage (i.e., MA-PD, D-SNP, FIDE SNP) products in accordance with federal and New York State laws, regulations, and contractual requirements. Serves as a subject matter expert in managed care regulations – with an emphasis on New York State Medicaid - collaborates with internal departments to promote a strong culture of compliance, and liaises with state and federal agencies on regulatory matters. The Manager has a deep understanding of healthcare compliance, regulatory frameworks, and risk management and possesses strong leadership and interpersonal skills, with the ability to influence and guide cross-functional teams. This individual works under general supervision.Responsibilities:

What We Provide

• Referral bonus opportunities     

• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays   

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life Disability    

• Employer-matched retirement saving funds   

• Personal and financial wellness programs    

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care     

• Generous tuition reimbursement for qualifying degrees   

• Opportunities for professional growth and career advancement    

• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities    

 

What You Will Do

• Ensures compliance with requirements established by the New York State Department of Health (DOH), Office of the Medicaid Inspector General (OMIG), Centers for Medicare & Medicaid Services (CMS), and other bodies overseeing managed care organizations.

• Monitors and interprets applicable federal and New York State statutes, regulations, and guidance affecting managed care organizations. Assesses the impact of State and Federal regulatory changes on the enterprise’s programs and health insurance plans.

• Serves as Project Manager for regulatory affairs projects related to new or updated regulatory guidance. Acts as the liaison with business areas to ensure appropriate changes are made to the impacted departments. Develops monitoring processes to ensure implementation is effective and compliant.

• Provides guidance to lines of business on compliance risks, ensuring operational readiness and adherence. Ensures that communications regarding high-impact regulatory changes are provided to key operational and shared services stakeholders. Develops and provides training and education on new or updated regulatory requirements to Compliance and operations, as applicable.

• Manages regulatory filings, submissions, and reporting obligations, including oversight of corrective action plans (CAPs), routine compliance reports, and required attestations. Manages the process for the issuance, development, remediation, and validation of regulator-issued CAPs for identified and/or reported issues of non-compliance.

• Assists in the review, development, revision and maintenance of compliance policies and procedures.

• Acts as an interface between Compliance Operations and Regulatory Affairs teams with respect to clarification of regulatory guidance.

• Collaborates with the Quality department to ensure that regulatory mandates, certain certifications, and survey responses are being tracked and monitored.

• Maintains a regulatory reference library for use by the department.

• Assists in the preparation of updates and reports to management, Board of Directors, and Compliance Committee related to regulatory affairs and related compliance activities.

• Participates in special projects and performs other duties as assigned

Qualifications:

Education: 

• Bachelor's Degree in healthcare administration, public health, business, law, or a health related field required required
• Master's Degree in a health or law-related field preferred

 

Work Experience:

• Minimum of four years of experience working in the health care industry, preferably with healthcare compliance, regulatory affairs, or managed care operations, with at least 3 years in a leadership or management role required
• Strong knowledge of Medicare and New York State Medicaid managed care regulations and compliance requirements required
• Demonstrated ability to research and interpret complex managed care regulations and communicate requirements effectively to operational teams. required
• Proven capacity to work collaboratively across departments and build strong compliance partnerships required
• Exceptional ability organizational, analytical, time management, project management and problem-solving skills required
• Excellent written and verbal communication skills required
• Fluent in Word, Excel, and Power Point required

Pay Range:USD $109,900.00 - USD $146,500.00 /Yr. Solicitar ahora