Regulatory Program Manager - Medicaid

EDI Staffing in Linthicum Heights, MD

  • Type: Full Time
position filled
Regulatory Program Manager - Medicaid

The Regulatory Program Manager-Medicaid manages Medicaid Regulatory Affairs for the Compliance department. This position supports the Director of Regulatory Compliance and the Chief Compliance officer in ensuring that the organization is compliant with federal requirements related to Medicaid managed care. Serves as the Project Manager for Medicaid compliance initiatives, particularly the organization's response to and implementation of action plans for new and updated regulatory requirements. Assists in the development, revision and management of compliance policy and procedure. Assist in developing and oversee communications, trainings and education, and related projects based legislative changes and other state Medicaid regulatory agency updates and identified regulatory gaps.

This is a position that incorporates technology design, operational design, process design, and project management. As such, the Program Manager must have an in-depth understanding of business strategy, how the organizational capabilities interrelate across the business, and the ability to determine the best path forward to execution of compliance objectives.

Essential Functions
  • 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
  • Guides internal customers on strategies, methods, and options for achieving operational/functional requirements applicable to Client and its' clients commercial and state insurance regulated products
  • Keeps abreast of federal and state regulations pertaining to Medicaid. Assesses the impact of Federal regulatory changes on the enterprise's programs, clients, and health insurance plans
  • Ensures that communications regarding high-impact regulatory changes are provided to appropriate business areas and executive leadership
  • Assists in the review, development, revision and maintenance of compliance policies and procedures and ensures all business/operational policies are updated to comply with law and regulations
  • Provide leadership, support, guidance, and training to internal teams relative to the organizations participation in client or state regulatory audits of Medicaid program operations
  • Collaborates with the Quality department to ensure that regulatory mandates, certain certifications, and survey responses are being tracked and monitored
  • Monitors changes in relevant regulatory areas. Develops and provides training and education on new or updated regulatory requirements tor Compliance and other business areas as applicable
  • Supports the submission of regulatory filings and reporting requirements on an ongoing basis
  • Provides input into the process for the issuance, development, remediation, and validation of regulator-issued corrective action plans (CAPs) for identified and/or reported issues of non-compliance with Medicaid requirements
  • Assists in the preparation of updates and reports to management, Board of Directors, and Compliance Committee related to regulatory affairs and related compliance activities.
  • Ability to effectively lead interactive meetings both onsite and remotely on a regular and predictable basis
  • Other activities, as needed, to support Client's compliance posture and vision to be the most trusted manage eye health and vision plan in the industry

Education and Experience
  • Bachelor's degree and a minimum of 5+ years' experience researching, collaborating and guiding functional areas on Medicaid requirements, within a multi-state Medicaid managed care organization or State Medicaid agency environment
  • Advanced degree in relevant discipline preferred but not required
  • A proven track record of collaborating effectively across all areas and levels of an organization is critical
  • An understanding of the regulatory environment and supporting multiple state Medicaid program requirements is a must
  • Proficient at reading, analyzing and working with healthcare or other complex laws, regulations and requirements
  • Strong working knowledge of Microsoft Office applications, including Power Point, Excel and Visio

  • Ability to build rapport quickly and collaborate in a fast paced environment
  • Excellent written and verbal communications skills
  • Results oriented
  • Thoroughness
  • Excellent judgement
  • Self-sufficient and accountable
  • Strong organizational skills

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