Program Manager Health Plans Regulatory Affairs - HP Regulatory

CHRISTUS Health•Irving, TX

About The Position

The Program Manager Health Plans Regulatory Affairs assists with implementing and maintaining the CHRISTUS Health Compliance Program. The role supports the Regulatory Affairs team in executing work priorities and plans and managing and monitoring operational compliance activities, including internal auditing and monitoring, external audit coordination, and regulatory training and education. The position reviews and researches laws and regulations related to Medicare Advantage and Health Exchange lines of business, monitors issue resolution and audit findings, analyzes and reports risk trends, and supports consistent compliance processes across health plan operations. It also develops and delivers specialized education, coordinates projects and external compliance audits, supports regulatory guidance, and cross-trains the Regulatory Affairs team. The role regularly interacts with senior leadership and other associates and helps resolve issues that may impede a high-performing team and work environment.

Requirements

Bachelor's degree in a related field of study, or equivalent years of work experience.
The role requires meeting the applicable OneCHRISTUS competencies.

Nice To Haves

4–6 years of related experience preferred.

Responsibilities

Meet expectations of the applicable OneCHRISTUS competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Review and research laws and regulations proactively and reactively to support accurate legal and regulatory compliance responses for Medicare Advantage and Health Exchange lines of business.
Monitor Health Plan progress in resolving issues identified through the Risk Assessment and Monitoring Work Plan and internal and external audit findings.
Analyze risk-related trends and periodically report them to the Compliance Committee.
Perform ongoing internal monitoring and audits based on risk level.
Support implementation of consistent processes that enhance compliance in day-to-day health plan operations.
Provide specialized education and develop materials as requested.
Follow up on action items related to audit requests and compliance issues.
Work with the Regulatory Affairs team to develop streamlined approaches across lines of business.
Cross-train the Regulatory Affairs team on compliance-related tasks.
Communicate and interact regularly with senior leadership and other associates.
Facilitate resolution of issues and concerns that create barriers to a high-performing team and work environment.
Manage project and monitoring work plans to achieve project goals and objectives.
Coordinate assigned projects, including monitoring projects for presentation to leadership and regulatory bodies.
Serve as project manager for external compliance audits conducted by regulatory bodies.
Serve as a resource on regulatory guidance for Health Exchange and Medicare lines of business.
Perform other duties as assigned.