Regulatory Affairs Director - Hybrid (Bronx Office)

About the Role

The Regulatory Affairs Director leads the Regulatory Affairs Department, overseeing contracts, compliance, audits, investigations, reporting, plan development, credentialing, fraud/waste/abuse investigations, provider network relations, and regulatory updates.

Responsibilities

• Review, draft, negotiate, and process agreements and amendments in accordance with organizational guidelines.
• Lead projects involving the collection and submission of data for government audits, surveys, and requests.
• Oversee provider contracting, including letters of agreement and follow-up.
• Review, disseminate, and handle fair hearing (FH) notices and decisions; manage FH calendar; attend FHs as needed; communicate with OTDA and submit reports.
• Lead activities of the Special Investigation Unit (SIU), including SIU reporting and internal investigations.
• Review and update HIPAA policies and procedures to ensure compliance with laws and regulations.
• Review OIG/OMIG requirements and best practices for compliance and program integrity; update compliance materials, manuals, policies, and handbooks.
• Make recommendations based on best practices and draft policies and procedures.
• Review DOH and CMS plan contracts and edit plan documents to comply with contract requirements.
• Review, clarify, and disseminate CMS memos and DOH guidance; stay current with related laws, regulations, and official guidance.
• Coordinate documents and requests for outside counsel on litigation matters.
• Oversee provider credentialing process and related activities.
• Draft policies, procedures, manuals, plan, and member materials.
• Provide guidance and direction to department staff.
• Perform other job-related duties as requested.

Requirements

• Juris Doctor (J.D.) degree from an accredited college/university.
• Five (5) years of experience with Medicare and NY Medicaid managed care contracting and compliance.
• Current, unrestricted Attorney license.
• Previous leadership experience preferred.

Skills

• Strong customer service and team orientation.
• Ability to adapt to a changing environment to achieve results.
• Demonstrated leadership skills.
• Skilled in organization, workflow analyses, and management of details.
• Advanced Microsoft Office skills, including Word.
• Strong editing and proofreading skills.
• Excellent written and oral communication skills.
• Excellent time/project management and prioritization skills.
• Ability to excel in a fluid, dynamic environment.

Working Conditions

• General office environment; may require sitting or standing for extended periods.
• Ability to travel as required by department needs.
• Hybrid schedule: 2 days remote, 3 days in the Bronx office per week.

Pay

$135,600.00 - $237,400.00 annual salary. CareSource considers education, training, experience, scope and complexity of the role, and other factors when determining compensation. In addition to base pay, you may qualify for a bonus tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package focused on employee well-being.