Director of Federal and Integrated Regulatory Guidance

About the Role

Oversee regulatory guidance for MetroPlusHealth’s Medicare Advantage and Integrated Products. This involves daily monitoring of state and federal communications, analyzing guidance, and translating it into simple language for impacted business areas. Develop implementation strategies and operational activities to ensure timely and compliant execution, while providing ongoing guidance throughout implementation projects. Monitor proposed guidance, share changes and impact with leadership, and contribute to state and federal policy development. Advise the sales and marketing team on permissible activities for marketing and outreach campaigns. Directly supervise a team of two.

Responsibilities

• Track state and federal regulatory changes, disseminate information to business leads in clear terminology, and develop implementation approaches and activities required for compliance.
• Participate and collaborate with cross-functional work groups to implement regulatory changes.
• Monitor proposed state and federal guidance and solicit input from impacted business leaders.
• Advise sales and marketing teams on permissible activities for marketing and outreach campaigns and related collateral.
• Review and update Policies and Procedures to ensure alignment with current regulatory standards.
• Track Medicare local coverage determinations to assist in policy and procedure review and development.
• Inform Senior and Executive Staff of potential compliance issues or delays in implementing regulatory and/or policy changes.
• Provide regular feedback to direct reports on performance and progress toward team goals.
• Engage with direct reports to identify career goals and areas for improvement.
• Perform other duties as assigned or requested.

Requirements

• Bachelor’s degree required.
• 5 years’ experience with Medicare and Integrated (Duals) products.
• 5 years’ experience in a compliance, regulatory affairs, or government affairs function within a Managed Care Organization.
• Knowledge of CMS rules and regulations as they relate to Medicare products and integrated/dual eligible plans.
• Understanding of managed care operations.
• Experience managing complicated projects, tracking details, and delivering work on time.
• Proven ability to articulate regulatory requirements to business and technical staff to achieve results.

Skills

• Solid Microsoft Excel skills and strong proficiency in MS Word, Excel, PowerPoint, and SharePoint.
• High-level skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to meet corporate deadlines and objectives.
• Excellent oral, written, analytical, and presentation skills; ability to interpret and summarize regulatory guidance.
• Ability to multi-task and manage multiple projects simultaneously.
• Utmost integrity in handling confidential materials discreetly and confidentially.