Our open opportunities JOBS

Job Ref: 93544
Department: OFFICE CORPORATE COMPLIANCE
Location: Downtown NYC

In Person: 2 days per week
Hire In Rate: $90,000.00
Salary Range: $90,000.00 – $101,000.00

About Client

Cure Staffing, Inc, DBA Cure the Executive Edge has partnered up with one of NYC’s most prevalent and prestigious insurance providers. Our client provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, and network including primary care providers, specialists and participating clinics. Over the last three decades, our client has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life and we are excited to help them accomplish this goal. We are seeking qualified, appropriately skilled professionals who can provide reliable and professional support. All candidates must have education, experience, licenses, and certifications that are applicable and appropriate to the level of this position.

Position Overview

The MLTC/MAP Regulatory Affairs Analyst, reporting to the Director of Regulatory Affairs, plays an integral role in the oversight and management of product regulatory activities in our Managed Long-Term Care (MLTC) and our Medicaid Advantage Plan (MAP) lines of business (LOB).  The MLTC/MAP Regulatory Affairs Analyst is responsible for promoting compliance with regulatory requirements to ensure department policies fulfill all NY State Department of Health (SDOH) regulations.

Job Description

• 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.
• Coordinate communication and respond to inquiries from different departments regarding questions or clarifications related to guidance or administrative directives sent by the State.
• 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 revised MLTC/MAP regulations and guidance.
• Apply knowledge of regulations and health plan operations to support implementation of best practices for business areas such as case management, administrative changes.
• Work with the Project Management Office (PMO) to manage, coordinate and participate in the implementation of contract changes for MLTC/MAP LOBs.
• Work closely with the Product Department and the Compliance Department to ensure that all activities related to MLTC, and MAP LOBs are addressed and in compliance with regulatory requirements.
• Participation in coalition calls and workgroups such as the NYS Operational Conference Calls, Health Plan Association (HPA) calls, PHP (Public Health Plans) Coalition including taking minutes and sharing with internal business areas as needed.
• Participate in all State initiated surveys related to MLTC and MAP and coordinate responses on any related Statement of Deficiency/Statement of Findings identified by the State.
• Report and escalate to management as needed.
• Support other regulatory related activities as needed.
• Prioritize and organize own work to meet deadlines.
• Other duties as assigned.

Minimum Qualifications

• Bachelor’s Degree required; Master’s Degree in Business Administration preferred
• Minimum three years of management experience in health care enrollment operations, preferably in a managed care environment; And
• Minimum three years of demonstrated experience in employee development and performance management;
• Demonstrated ability to develop workflows, policies, and procedures
• Demonstrated ability to identify opportunities for improvement and implement solutions
• Knowledge in (Medicaid, QHP, EP, CHPlus, Gold, MAP) enrollment policies

Professional Competencies

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