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Healthfirst

Sr Regulatory Mgr, Medicare Analysis

The Sr. Regulatory Manager, Medicare Analysis, ensures that new regulations and requirements impacting the Medicare Advantage and Part D programs are communicated to the organization to ensure implementation in accordance with regulatory requirements within required timeframes. This position will notify leadership on important initiatives and proposed changes to the Medicare Advantage and Part D programs impacting the organization. This position will also maintain, ensure, and foster an environment that enhances and promotes compliance, adherence to corporation's ethical standards and conformance to all relevant federal, state and local laws, rules and regulations applicable to the company's State and Federal contracts for Healthfirst's Medicare Advantage (MA) product offerings.

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Job Description

  • In conjunction with the Healthfirst Legal department, interprets changes to CMS requirements and program rules. Tracks, monitors, and conducts impact analyses for all statutory, regulatory, sub-regulatory and contractual updates for all Medicare programs, including, but not limited to: Notices of Proposed Rulemaking (NPRM), Final Rules, HPMS memos, NCDs/LCDs, Medicare Learning Network and other programmatic changes impacting Medicare Advantage and Part D.
  • Performs research and analysis of changes to Medicare program regulations, policies and contractual requirements, assists in assessment of operational risks/impact to functional departments.
  • Prepares and facilitates executive-level presentations on such changes at Executive, Medicare Leadership, and Corporate Leadership meetings. Communicates direction from Sr. Leadership and VPs in helping to develop business solutions and goals to achieve compliance and meet those goals/objectives.
  • In conjunction with the Healthfirst Compliance department, assesses compliance with internal policies, procedures and workflows and new and revised CMS requirements; works with departments to implement corrective actions as necessary to meet and/or maintain acceptable internal and CMS performance levels.
  • Provides innovative solutions to solve complex operational and business issues impacting the Medicare Part C and D programs.
  • Provide assistance and guidance to other Medicare Regulatory Managers in managing work and resources to ensure routine administrative requirements and deadlines are met; proactively conducts process improvements to ensure departmental operations are efficient.
  • This position is responsible for supporting the Medicare line of business strategy and execution.
  • The incumbent will be knowledgeable in all Medicare products, including Medicare Advantage, Part D Prescription Drug Plans, and Dual Eligible products.
  • Assists the appropriate business areas, including Regulatory Change Management to implement special projects, initiatives, and activities to support line of business objectives, product, benefit administration, process improvement, efficiency, and the customer experience in accordance with CMS requirements.
  • Develops and maintains relationships across the enterprise to promote consistent strategic priorities.
  • Facilitates the weekly HPMS Memo Review Forum with internal stakeholders.
  • May serve as a regulatory liaison to CMS, DOH, or other regulatory agencies as needed.
  • Represents the Regulatory Affairs department on related key cross-functional committees and projects to ensure Medicare perspective is being integrated into strategies of other areas.
  • Acts as a consultant to internal departments regarding regulatory issues while understanding the underlying root cause and applicable regulatory requirements, conducts analysis of risk, and recommends or initiates necessary corrective action.
  • Reviews and approves policies and procedures to ensure regulatory requirements are met.

Minimum Qualifications

  • Bachelor's Degree from an accredited institution or equivalent work experience.
  • Demonstrated experience in analysis of state/federal policy as it applies to the health care industry, specifically related to Medicare Advantage and Medicare Part D.
  • 5-7 years of experience working in operations and a thorough understanding of business processes of the Medicare Part C and D programs.
  • 3-5 years experience in a program management or analytical role; creativity and initiative in problem solving and solution identification.
  • Must be capable of establishing effective relationships with all levels of representation throughout the organization.
  • Strong facilitation skills and follow through.

Compliance & Regulatory Responsibilities

  • In this role, all job duties are Compliance and Regulatory Responsibilities. See list in the "Job Profile Summary" section.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid "@healthfirst.org" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

Hiring Range:

  • Greater New York City Area (NY, NJ, CT residents): $119,900 - $183,430
  • All Other Locations (within approved locations): $102,600 - $156,655

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.

Job ID: healthfirst-R017643
Employment Type: Other

Perks and Benefits

  • Health and Wellness

    • Health Insurance
    • Health Reimbursement Account
    • Dental Insurance
    • Vision Insurance
    • Life Insurance
    • Short-Term Disability
    • Long-Term Disability
    • FSA
    • HSA
    • Fitness Subsidies
    • Mental Health Benefits
    • Pet Insurance
  • Parental Benefits

    • Birth Parent or Maternity Leave
    • Family Support Resources
  • Work Flexibility

    • Remote Work Opportunities
    • Hybrid Work Opportunities
  • Office Life and Perks

    • Commuter Benefits Program
    • Casual Dress
    • Happy Hours
    • Company Outings
    • Holiday Events
  • Vacation and Time Off

    • Paid Vacation
    • Paid Holidays
    • Personal/Sick Days
    • Volunteer Time Off
  • Financial and Retirement

    • 401(K) With Company Matching
    • Performance Bonus
  • Professional Development

    • Internship Program
    • Tuition Reimbursement
    • Promote From Within
    • Access to Online Courses
    • Lunch and Learns
    • Associate or Rotational Training Program
    • Learning and Development Stipend
  • Diversity and Inclusion

    • Employee Resource Groups (ERG)
    • Woman founded/led
    • Diversity, Equity, and Inclusion Program

Company Videos

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