ACO Regulatory Strategy Manager

Summary:

The ACO Regulatory Strategy Manager is a critical role focused on mastering and staying current with Accountable Care Organization (ACO) models such as ACO REACH, MSSP, and ACO PCP Flex under CMS guidelines. This position requires a high level of expertise in understanding the evolving landscape of these programs, including their financial, administrative, and operational nuances. The manager will monitor CMS communications, participate in relevant CMS educational sessions, and translate complex regulatory information into strategic plans for the organization. The manager will also be responsible for managing the end-to-end application process for new ACO programs.

Essential Duties and Responsibilities:

• Regulatory Monitoring: Maintain an up-to-date understanding of all aspects of CMS ACO programs, including regulatory changes, deadlines, and compliance requirements. Collaborate with functional leads to ensure all CMS deadlines are met satisfactorily. Lead on all CMS compliance audits, including annual Voluntary Alignment submission audits.
• Educational Engagement: Actively participate in CMS-hosted webinars, workshops, and conferences to gather insights and remain informed about ACO program developments. Ensure that all updates are communicated across the organization as applicable.
• Data Analysis: Analyze program data and CMS updates to assess their impact on current practices and future strategies. Use insights to guide organizational adjustments and enhancements.
• Documentation and Reporting: Develop comprehensive reports and presentations that summarize program updates, analyze potential impacts, and recommend strategic actions. Manage a Regulatory Affairs email distribution, sending updates with attachments, subject line references, and specific narratives to relevant stakeholders.
• Strategic Implementation: Work closely with organizational leadership to align ACO program strategies with broader healthcare goals and ensure compliance with CMS regulations. Develop, update, and implement ACO program training material for existing and new hires.
• Stakeholder Communication: Serve as the expert point of contact for all ACO-related queries within the organization and for external partners. Ensure clear and consistent communication regarding program changes and requirements. Lead recurring CMS meetings with our assigned representative and incorporate key take-aways into presentations and communications.
• Application Process Management: Lead and manage the end-to-end application process for entering new ACO programs, including preparation, submission, and follow-up on all application materials and communications. Transition oversight of the Voluntary Alignment submissions to this role, ensuring compliance and tracking.

Knowledge, Skills and Abilities:

• Familiarity with healthcare regulatory environments and compliance requirements. Experience with ACO REACH, MSSP, and PCP Flex is a bonus.
• Excellent report writing and presentation skills. Able to interpret complex regulatory information and transform it into actionable strategies.
• Capable of maintaining up-to-date knowledge of evolving healthcare regulations.
• Ability to communicate effectively with various stakeholders, both internal and external.
• Strong strategic thinking and problem-solving abilities.

Minimum Education and Experience:

• Bachelor’s degree in a relevant field such as Healthcare Administration, Public Health, Healthcare Management, Health Policy, or a related field.
• Minimum of 2 years of experience in healthcare policy, regulatory affairs, healthcare administration, or a related area.

Preferred Qualifications:

• Experience with CMS programs, particularly with ACOs, Medicare, or Medicaid, though direct experience with CMS is not required.
• Familiarity with regulatory compliance frameworks and experience in developing compliance strategies.
• Prior involvement in healthcare program evaluation or policy analysis projects that required a detailed understanding of programmatic impacts, including the application processes.