Director of State Regulatory Guidance

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

About NYC Health Hospitals

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

As Director of State Regulatory Guidance for NYS products, you will manage a team of regulatory professionals who analyze new regulatory requirements, work closely with the business to understand the impact and obligations of those requirements, and support the business in understanding the evolving regulatory landscape.

With wide latitude for individual initiative and decision making, the position is responsible for providing leadership and oversight related to all products offered by MetroPlus Health .

Job Description

• Provide leadership and expertise in analysis and interpretation of complex and voluminous enacted state laws state across the MetroPlusHealth portfolio of state businesses, both government programs and commercial.
• Direct and supervise the Regulatory Guidance team to ensure that all new regulations and product contract updates are disseminated throughout the organization.
• Provide regulatory support to the organization, including providing regulatory interpretation and gaining clarification from regulatory bodies.
• Proactively communicate with internal divisions to become and remain educated about key regulatory issues affecting these areas.
• Support continuous improvement of communication processes to better inform the enterprise of new legislation and regulatory agency directives.
• Develop and maintain relationships with regulatory agencies and stay up-to-date on any changes or updates to regulations.
• Participate in stakeholder calls and create summaries of calls for dissemination to senior staff.
• Work with the Regulatory Operations team to support the preparation and submission of regulatory filings, reports, and documentation.
• Identify and assess potential regulatory risks and develop strategies to mitigate those risks.
• Collaborate with cross-functional teams to ensure compliance across all areas of the organization.
• Participate in high-level implementations of carve-in / carve-out services; program services such as changing vendors or adding new vendors.
• Assist the Compliance teams with understanding of Federal, State and Local regulations and product contract requirements.
• Partner with Compliance team on management of and response to external audits and surveys relating to NY State product offerings, including NYS Department of Health Article 44 program audits.
• Participate in engagement with Local and State agencies and Trade Associations.
• Demonstrate strategic mindset to deliver value to business teams.
• Support and coordinate with business leaders on regulatory changes to drive achievement of business goals and clarity of regulator expectations.
• Anticipate policy and emerging regulatory trends and coordinate advocacy strategies with government relations team.
• Cultivate and maintain solid collaborative relationships with business clients, regulators and MetroPlusHealth business partners.
• Supervise a team of Regulatory Analyst staff assigning tasks and projects and conducting performance evaluations.
• Ensure that the team is adequately trained and equipped to perform their duties, including identifying and addressing knowledge and skill gaps and that staff are up to date with work assignments and provide guidance as needed.
• Provide feedback to staff to help improve their productivity, efficiencies, and growth.
• Other duties as assigned by the Senior Director or Chief Compliance & Regulatory Officer.

Minimum Qualifications

Professional Competencies :

Communicating with others

LI-Hybrid