Director DHP Regulatory Operations

DRISCOLL HEALTH PLAN•Corpus Christi, TX

22h

About The Position

The Driscoll Health Plan ("DHP") Director of Regulatory Operations is responsible for the development, implementation, and oversight of an effective regulatory program for DHP. In this role, the Director will be instrumental in the coordination, communication and guidance to internal stakeholders regarding applicable State and Federal rules and regulations and State contractual requirements. The Director is also responsible for professional engagement with regulators in order to communicate the needs of DHP, as well as, to coordinate responses to requested regulatory deliverables such as government filings for the Texas Health and Human Services Commission ("HHSC"), Texas Office of Inspector General ("OIG"), Texas Department of Insurance ("TDI"), as well as other regulatory agencies as needed. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes.

Requirements

Bachelor’s Degree required.
At least 5 years of experience in Managed Care and/or Health Plan leadership, including experience and knowledge in Texas Medicaid lines of business, health plan operations, regulatory oversight and compliance filing requirements.
Alternatively, any combination of education and experience, which would provide an equivalent background.

Responsibilities

Acts as an expert managed care resource for DHP internal stakeholders regarding state and federal regulations that may affect DHP and provides guidance when regulatory reports and deliverables are requested.
Monitors and interprets new and revised Texas Uniform Managed Care Contract (“UMCC”) and Uniform Managed Care Manual (“UMCM”) requirements and communicates applicable changes to internal DHP stakeholders.
Develops and oversees a robust delegated oversight program which includes auditing and monitoring of DHP delegated entities as well as the implementation and monitoring of delegated entity corrective action and remediation plans.
Oversees the development, tracking and submission of reports, regulatory filings, and audits to HHSC, OIG, TDI and other regulatory agencies on behalf of DHP.
Establishes and maintains collaborative relationships with applicable external regulatory agency representatives.
Oversees the coordination, communication and response from internal stakeholders regarding questions or clarifications related to guidance or administrative directives provide by regulatory agencies.
Represents DHP in regular and ad-hoc regulatory agency oversight meetings.
Represents DHP in scheduled or ad-hoc HHSC, Texas Association of Health Plans (“TAHP”), Texas Association of Community Health Plans (“TACHP”) and other applicable collaborative meetings in order to track and share information and guidance with DHP Leadership that could inform operational decision making.
Oversees the DHP contract management process.
Mentors, develops and imparts knowledge to aid regulatory staff development, ensure cross-coverage so that the regulatory team and departmental operations remain agile and effective.
Effectively administers performance management system including: Developmental feedback, Goal setting, Assesses competency, Progressive discipline
Makes and implements decisions compatible with organizational goals.
Maintains confidentiality, composure, effectiveness, and flexibility under pressure.
Other duties as reasonably assigned.