Manager of Medicaid Regulatory Compliance

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Manager of Medicaid Compliance reports to the Director of State Regulatory Compliance. The Manager of Medicaid Compliance will support the oversight and management of Medicaid regulatory compliance activities, including monitoring of all related regulatory guidance for compliance work plan activities, supporting the organization with corrective actions and regulatory disclosures, contributing to the annual compliance risk analysis and work plan. The position also ensures that the Medicaid Compliance plan and related Compliance training are accurate and updated.

Job Description

• Assist the Director of State Regulatory Compliance in the development of the annual risk assessment and implementation of the annual work plan ensuring the gathering and provision of Medicaid regulatory compliance related information.
• Manages audit readiness activities with impacted business areas.
• Supports the regular development and review of regulatory compliance policies and procedures for the general operation of the Plan's compliance program and its' related activities for Medicaid.
• Conducts auditing and monitoring activities for Medicaid as outlined in Compliance Work Plan.
• Develops reports covering Medicaid Regulatory Compliance activities for the Compliance Committee and Audit and Compliance Committee of the Board of Directors.
• Upon identification of non-compliance, 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. Plays a critical role in driving the progress for corrective action plans throughout the organization.
• Assist business areas in creating, monitoring, and updating metrics to assess continued compliance with regulatory requirements.
• Provides support to the Director of State Regulatory Compliance in Article 44 related audits.
• Oversees the daily functions of the Medicaid Regulatory Compliance team to ensure:
  • Proper investigation of all Medicaid regulatory compliance related issues.
  • Compliant implementation of state policy changes and updates. Working with the team to synthesize regulatory guidance into Compliance activities and tracking related due dates and providing support to business areas completing deliverables.
• Support the Director of State Regulatory Compliance with any required regulatory activity.
• Oversee a team of staff dedicated to managing implementations and compliance issues.
• Other duties as assigned or requested.

Minimum Qualifications

• A Bachelor's degree required.
• 5 or more years of Medicaid Managed Care experience.
• 3-5 years' experience in a compliance, regulatory affairs, or government affairs function within a Managed Care Organization.
• Prior successful experience working with regulators on compliance audits, reporting and other matters.
• Experience managing complicated projects, keeping track of details, and staging work to deliver projects on time.
• Proven ability to articulate regulatory requirements to business and technical staff to capture information and achieve results.
• Experience with developing reporting and metric.

Professional Competencies

• Broad-based in-depth knowledge of the managed care industry, including: strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles. The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
• The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
• Experience working with regulators on compliance audits, reporting and other matters.
• Experience with managed care, Medicaid and federal regulations, quality improvement and compliance oversight.
• High-level of skill in leading interdepartmental and cross-functional projects; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
• Excellent oral, written, and presentation skills, state as well as conceptual and analytic skills are necessary to review and articulate corporate objectives and Federal regulations across all relevant audiences.
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary.

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