Healthfirst

The Regulatory Manager, Analysis & Impact, 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 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.

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, and helps develop business solutions that allow Healthfirst to achieve compliance and simultaneously meet business 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. 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. Strong process and program management skills, analytical, 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. License/Certification

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $100,900 - $145,775 All Other Locations (within approved locations): $86,500 - $128,690 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.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.