Regulatory Affairs/Contract Administrator

Phoenix AZ 85034

Job Description

The Regulatory Affairs/Contract Administrator is responsible for maintaining the organization's relationships with state and federal regulatory agencies with jurisdiction to monitor and oversee adherence to its contracts to operate in various government programs and otherwise assures that regulator(s) deliverables and expectations are met by the business. This position requires effective leadership as a subject matter expert in government programs and healthcare regulatory requirements, balanced with the ability to complete a variety of detailed analyses and assessments, including the on-going evaluation 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 initiatives driven by state and federal regulatory requirements. The Regulatory Affairs/Contract Administrator will work to ensure the objectives of the organization are met, especially the establishment and maintenance of a productive, communicative, and transparent relationship with various state and federal regulators (e.g., Medicaid agency, Departments of Health or Insurance, CMS), exercising advocacy on behalf of the health plan as appropriate. This position will closely partner and collaborate with business leadership, department management, employees at various levels, and legal counsel, as well as regulatory agency contacts. This position also supports Public Sector Compliance and organizational leaders and staff on related initiatives.

Essential Functions

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  • Leads and maintains the day-to-day relationships with state and federal regulatory departments/agencies with jurisdiction to support contract compliance and business operations in the Medicaid/Medicare program(s) in which the Magellan Complete Care health plan participates. 
  • Analyzes, interprets and serves as thought leader  in business decisions regarding the regulatory implications of changes to statutes, regulations, sub-regulatory guidance, and contracts. 
  • Leads and facilitates regulatory audits and audit readiness activities. 
  • Leads and facilitates the submission of regulatory filings and reporting deliverables on an ongoing basis. 
  • Leads 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 and effectively represents the business in communication with the regulators regarding such CAPs. 
  • Works with internal departments in the submission of provider and member materials for the various programs (e.g., marketing collateral, denial letters, provider directories). 
  • Serves as a critical leader  in the review, development, revision, and maintenance of policies and procedures related to the various programs and contracts. 
  • Prepares updates and reports to management, Board of Directors, and Compliance Committee related to regulatory affairs and related regulatory adherence activities. 
  • Participates in the development and implementation of process improvements for the organization, particularly those tied to adherence with regulatory requirements. 
  • Keeps current on the local, state, and federal regulatory environment to identify issues that may impact organization's programs. 
  • Supports and facilitates the Medicaid/Medicare 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, leads, and administers a complex project plan for the achievement of regulatory goals and objectives. 
  • Builds strong regulatory relationships at the state and federal level. 
  • Translates complex concepts into clear messages for and on behalf of the organization and business leadership. 
  • Establishes and maintains effective working relationships with all levels of staff and regulatory agencies. Formulates and interprets regulations, policies, and procedures. 
  • Other accountabilities and duties as assigned. 

General Job Information

Title

Regulatory Affairs/Contract Administrator

Grade

29

Job Family

Legal Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

10/16/2019

Date Requisition Created

10/16/2019

Work Experience

Government Affairs, Healthcare, Management/Leadership, Project/Program Management

Education

Bachelors: Healthcare (Required), Masters: Healthcare

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Preferred Qualifications

  • Master’s degree 
  • Project management/leadership  experience 

Required Qualifications

  • Bachelor’s degree in a health care related field.
  • 7+ 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 accountabilities and deliverables. 
  • Ability to translate complex concepts into clear, concise and compelling 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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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