Manager, Regulatory (Medicare Advantage and ACA) - JHP

Jefferson Health Plans • Philadelphia, PA

20d

About The Position

The Manager, Regulatory (Medicare Advantage and ACA) serves as a strategic, forward-thinking compliance leader, ensuring the organization meets all federal and state regulatory requirements for Medicare Advantage and ACA-compliant individual and small group health plans. This role is pivotal in interpreting complex regulations, shaping organizational responses, and driving innovative, results-oriented implementation strategies that safeguard compliance and support business objectives. As a visionary and trusted advisor, they proactively monitor evolving regulatory landscapes, evaluates policy impacts on operations, and leads the organization in oversight and preparation of filings and communications with oversight agencies such as CMS and state Departments of Insurance (DOIs). The position requires and empathetic, collaborative, and diplomatic approach, partnering closely with internal stakeholders to interpret regulatory changes, operationalize requirements, mitigate risk, and maintain adherence to CMS and state mandates. The ideal candidate is a highly analytical, meticulous, and resilient professional with deep expertise in health insurance regulations including ACA, HIPAA, CMS, and state DOI requirements and proven experience engaging with regulatory bodies. This individual combines strategic insight, strong communication skills, and execution excellence, serving as an influential leader who ensures compliance while enabling organizational growth. This role is responsible for managing day-to-day regulatory activities, coordinating submissions, and ensuring operational adherence to complex federal and state regulations. Reporting to the Director of Regulatory Affairs, the Manager will lead a team of regulatory analysts, oversee project execution, and serve as a key resource for regulatory interpretation and guidance within the organization.

Requirements

• Bachelor’s degree in public health, Business Administration, Health Policy, Law, or a related field.
• 5-7 years of experience in a regulatory or compliance role within the health insurance, healthcare, or managed care industry.
• Knowledge of applicable federal and state health insurance regulations, including ACA, CHIP, HIPAA, Medicare, and Medicaid.
• Experience dealing with regulatory agencies such as CMS and state DOIs.
• A strong understanding of ACA and Medicare benefits and regulations, including QHP and Medicare Advantage requirements and state/federal Exchange operations.
• Strong leadership skills with experience managing or mentoring team members.
• Excellent organizational, analytical, and project management skills.

Nice To Haves

• Juris Doctor (JD) or Master’s degree in a relevant field is a plus.
• Experience preparing or supporting CMS and DOI filings is strongly preferred.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 501-1,000 employees