Regulatory Affairs Director - Hybrid

CareSource•New York, NY

1d•Hybrid

About The Position

The Regulatory Affairs Director is responsible for leading activities of the Regulatory Affairs Department, including contracts, compliance, surveys, audits, investigations, reporting, plan development and renewal, credentialing, Fraud, Waste & Abuse Special Investigations, provider network and relations, regulatory updates and compliance matters. CareSource is highly invested in every employee’s total well-being and offers a substantial and comprehensive total rewards package. The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Requirements

Juris Doctor (J.D) degree from an accredited college/university required
Five (5) years experience with Medicare and NY Medicaid managed care contracting and compliance required
Strong customer service and team orientation
Ability to adapt to a changing environment to achieve results
Demonstrated leadership skills
Skilled in organization, workflow analyses and management of details
Advanced Microsoft Office skills, including Word
Strong editing and proofreading skills
Excellent written and oral communications skills
Excellent time/project management and prioritization skills
Ability to excel in fluid, dynamic environment
Current, unrestricted Attorney license required

Nice To Haves

Previous leadership experience preferred

Responsibilities

Review, draft, negotiate and process agreements and amendments in accordance with organization guidelines.
Lead projects involving the collection and submission of data and information related to government audits, surveys and requests.
Oversee provider contracting, including letters of agreement and associated follow-up.
Review, disseminate and handle fair hearing (FH) notices and decisions; manage FH calendar; attend FHs as needed, review and handle communications with OTDA and submit reports; prepare status reports and updates on cases.
Lead activities of the Special Investigation Unit (SIU), including SIU reporting and internal investigations.
Review and update applicable HIPAA policies and procedures in compliance with HIPAA laws and regulations.
Review OIG/OMIG requirements and best practices for compliance and program integrity; review and update compliance materials, including manuals, policies and procedures, and handbooks, to comply with regulatory requirements.
Make recommendations based on best practices and draft policies and procedures.
Review DOH and CMS plan contracts and edit plan documents in compliance with contract requirements.
Review, clarify and disseminate CMS memos and DOH guidance; keep abreast of related laws, regulations and official guidance.
Coordinate document and requests of outside counsel for litigation matters.
Oversee provider credentialing process and related activities.
Draft policies, procedures, manuals, plan and member materials.
Provide guidance and direction to Department staff.
Perform any other job related duties as requested.