Commercial Regulatory Guidance Specialist

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

MetroPlusHealthis 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 Commercial Regulatory Affairs Specialist, reporting to the Director of State Regulatory Guidance, plays an integral role in the oversight and management of product regulatory activities our commercial Lines of Business including Essential Plan (EP), Quality Health Plans (QHPs) and Large Group products. The Commercial Regulatory Specialist is responsible for promoting compliance with regulatory requirements to ensure department policies fulfill all NY State Department of Health (SDOH) and Department of Financial Services (DFS) regulations.

• Monitor, interpret, distribute, track, and assess new State regulatory guidance (including all guidance documents, memos, administrative directives relative to all Commercial compliance/regulatory communications.
• Ensure that most recent contract changes are reflected departmental policies and process by monitoring government, healthcare, and public websites, memos, and other sources to identify new and changed commercial regulations and guidance.
• Review and interpret State regulatory guidance (i.e., benefit changes; rate changes; process changes); prepare impact analysis for dissemination to business units for implementation of processes. Work with business units to ensure implementation is complete and meets the regulatory requirements.
• Apply knowledge of regulations and health plan operations to support implementation of best practices for business areas i.e., Enrollment, Marketing, Retention/Customer Experience and Claims.
• Work with the Product and/or Project Management Office (PMO) to develop Project Plans for budget implementation actions related to changes such as eligibility changes and benefit changes which impact the Commercial LOBs.
• Provide guidance to PMO on issues of clarification, additional research or processes related to Commercial LOBs.
• Participation in coalition calls and workgroups such as the NYSoH Technical Calls, Health Plan Association (HPA) calls, including taking minutes and sharing with internal business areas as needed.
• Complete timely research for regulatory questions on department processes, policies and procedures, or materials for applicable business units.
• Assist with external regulatory audits, surveys and regulatory reporting.
• Support other regulatory related activities as needed.
• Provides explanations and information to others on regulatory issues and requirements.
• Work to ensure knowledge of State Sponsored products is up to date.
• Provides support for the management of projects impacting one or more business areas such as the Product Team to ensure the correct implementation of State regulatory requirements.

• Bachelor's degree required; and
• 5+ years of Regulatory Affairs work experience.
• 5+ years of experience with MS Word, Excel, Sharepoint and PowerPoint required.
• Experience in a position requiring independent judgment and initiative.
• Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
• Master Degree referred
• Experience with State Exchange products strongly preferred.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

#LI-REMOTE

#MPH-50