Manager, Regulatory (Medicare Advantage and ACA) JHP
Share
Job Location:
Philadelphia, PA - USA
Monthly Salary:
Not Disclosed
Posted on:
16 days ago
Vacancies:
1 Vacancy
Job Summary
Job Details
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.
Job Description
Minimum Education and Experience Requirements:
Education:
- Bachelors degree in public health Business Administration Health Policy Law or a related field.
- Juris Doctor (JD) or Masters degree in a relevant field is a plus.
Experience: - 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.
- Experience preparing or supporting CMS and DOI filings is strongly preferred.
- Strong leadership skills with experience managing or mentoring team members.
- Excellent organizational analytical and project management skills.
#LI-Remote
Work Shift
Workday Day (United States of America)Worker Sub Type
RegularEmployee Entity
Health Partners Plans Inc.Primary Location Address
1101 Market Philadelphia Pennsylvania United States of AmericaNationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.
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 diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.
For more benefits information please click here
Required Experience:
Manager
Key Skills
- Proofreading
- Adobe Acrobat
- FDA Regulations
- Manufacturing & Controls
- Biotechnology
- Clinical Trials
- Research & Development
- GLP
- cGMP
- Product Development
- Chemistry
- Writing Skills
About Company
At Thomas Jefferson University in Philadelphia, PA, we are helping you to redefine what’s possible with innovative and tailored education opportunities.
