Description and Requirements Responsible for developing and implementing strategies to ensure clinical compliance with regulatory requirements. Primary duties include regulatory oversight, regulatory support, regulatory change management, and management of policy documentation. The Director strengthens Clinical Operations’ regulatory position by ensuring support for regulatory scope change implementations, leading audit support and audit readiness functions, and facilitating corrective action plans (CAPs). Leads department efforts related to audit preparation, responses, and corrective action plans surrounding quality, Model of Care, and any other form of information requested from the team that could possibly have regulatory implicationsMonitors changes in regulations and ensures the organization’s policies and procedures are updatedEnsures that Clinical Operations policies undergo annual review to include ensuring any required updates and approvals are complete, accurate, and timelyOversees regulatory submissions and reports to agencies e.g. NYS DOH, CMS, etc.Collaborates with stakeholders across the organization to establish timelines and obtain required information in support of regulatory actionsOversees regulatory implementation effortsCommunicates with regulatory agencies and other external organizationsEnsures that Healthfirst meets requirements for all lines of business by developing requirements, documenting the activities that meet the requirements, and collaborating with stakeholders to close gaps as neededManages SNP Model of Care Committee which includes implementing and maintaining a committee structure, working with stakeholders to prepare for committee meetings, and managing committee membershipDevelops and maintains departmental work plans and policies & procedures to ensure Healthfirst meets all regulatory requirementsSupervises the performance of direct reports and provides training and development opportunities; manages and holds team accountable for workload; conducts interviews, handles employee relations, and evaluates performance to develop a high functioning teamAdditional duties as assigned or needed

Minimum Qualifications:

Bachelor's degree from an accredited institution or equivalent work experienceExperience leading/supporting regulatory activities/audits
 

Preferred Qualifications:

Master's degree from an accredited institutionPrevious experience in managing staff and developing staffExpertise reading and interpreting regulatory requirements for healthcare/managed care organizationsExpertise developing work plans and organizing work to execute against timelines Work experience requiring effective communication with internal and external stakeholders in a variety of formats, both written (i.e., Word documents, Excel spreadsheets, PowerPoint presentations) and oral (i.e., conference calls, face-to-face meetings and presentations)

Compliance & Regulatory Responsibilities: See Above

License/Certification: N/A

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $150,800 - $230,690

All Other Locations (within approved locations): $124,400 - $190,315

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.