Regulatory Affairs Director - Hybrid

CareSource Management Services•New York City, NY

5d•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.

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
Current, unrestricted Attorney license required

Nice To Haves

Previous leadership experience preferred
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

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.