Job DescriptionThe Regulatory Affairs Manager is primarily responsible for maintaining the organization's relationships with state regulatory agencies with jurisdiction to monitor and oversee adherence to its contracts to operate in various programs. This position requires the ability to complete a variety of detailed analyses, including the assessment of the impact of State and Federal regulatory changes on the organization's programs and related state-sponsored government programs. This position leads and manages projects and other assignments tied to state regulatory requirements, deliverables and expectations. The Regulatory Affairs Manager will work to ensure the objectives of the Public Sector Compliance team and the organization are met, especially the establishment and maintenance of a productive, communicative, and transparent relationship with various state regulators (e.g., Medicaid agency, Departments of Health or Insurance), exercising advocacy on behalf of the health plan as appropriate. This position will closely partner and interact with leadership, department management, and legal counsel, as well as state regulatory agency contacts. This position also supports other Public Sector Compliance and organizational leaders and staff on related projects as assigned.
- Manages the day-to-day relationships with state regulatory departments/agencies with jurisdiction to support contract compliance and business operations in the Medicaid program(s) in which the MGLN health plan participates.
- Analyzes, interprets and makes recommendations regarding the regulatory implications of changes to statutes, regulations, sub-regulatory guidance, and contracts.
- Leads and facilitates regulatory audits and audit readiness activities.
- Manages the submission of regulatory filings and reporting requirements on an ongoing basis.
- Manages the process for the issuance, development, remediation, and validation of regulator-issued corrective action plans (CAPs) for identified and/or reported issues of non-compliance.
- Works with internal departments in the submission of provider and member materials for the various programs (e.g., marketing collaterals, denial letters, provider directories).
- Assists in the review, development, revision, and maintenance of policies and procedures related to the various programs.
- Assists in the preparation of updates and reports to management, Board of Directors, and Compliance Committee related to regulatory affairs and related compliance activities.
- Assists in the development and implementation of process improvements for the Public Sector Compliance department.
- Keeps current on the local, state, and federal regulatory environment to identify issues that may impact organization's programs.
- Supports and facilitates the Medicaid business development processes for related companies.
- Represents organization at various internal and external meetings.
- Works with all of organization in supporting Magellan departments and functions in response to inquiries, problem-solving, and promoting the company’s mission and message.
- Organizes and administers a complex project plan for the achievement of regulatory goals and objectives.
- Builds strong regulatory relationships at the state level.
- Translates complex concepts into clear messages.
- Establishes and maintains effective working relationships with all levels of staff and regulatory agencies.
- Assists in the formulation and interpretation of policies, procedures and regulations.
- Other projects and duties as assigned.
General Job Information
TitleRegulatory Affairs Manager - Cambridge, MA
Job FamilyLegal Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date11/1/2018
Date Requisition Created11/1/2018
EducationBachelors (Required), Masters
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- Master’s degree preferred.
- Medicare experience preferred.
- Bachelor’s degree in a health care related field, or equivalent work experience required.
- 5+ years of experience in government or health care in a public or regulatory affairs role.
- Experience in health care, health plans, Medicaid, Long-Term Care,; Medicare preferred
- Knowledge of regulatory requirements related to Medicaid, Medicare Advantage, Medicare Part D, Medicare-Medicaid Plans (MMPs) and/or some other equivalent in government programs.
- Proficiency in Microsoft Office applications: Word, Excel, PowerPoint and Visio.
- Communicates effectively, both verbally and in writing, with all levels of staff, other agencies, and stakeholders.
- Possesses exceptional initiative and follow-through on projects with minimal supervision or guidance.
- Ability to translate complex concepts into clear messages.
- Demonstrates effective team coordination and cooperation and motivates others to do so.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
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