Manager, Regulatory Affairs - Medicare

Inland Empire Health Plans
Rancho Cucamonga CA
30+ days ago

Job Description

Position Summary/Position

Under the direction of the Director of Compliance, the Regulatory Affairs Manager (Medicare) is responsible to achieve and oversee compliance with Centers for Medicare & Medicaid Services (CMS) Medicare guidelines, regulations, and contractual requirements and to assist with implementation of these requirements into internal operational processes. The Regulatory Affairs Manager (Medicare) has an active and visible leadership role with CMS.
Under the direction of the Director, Compliance. the Manager, Regulatory Affairs (Medicare) serves as a lead liaison for IEHP with regulatory agencies, and positions IEHP as a key influencer, maintaining relationships with CMS. This position works collaboratively with other departments within the Plan acting as a resource to provide analysis and interpretation of regulatory policy guidance, and work with Business Units to ensure compliance with the regulatory requirements of the guidance issued. Additionally, the Manager, Regulatory Affairs (Medicare) plays a key role in crafting and shaping federal regulatory policy issues for the benefit of IEHP.
The Regulatory Affairs Manager (Medicare) must promote open and candid discussions regarding Medicare compliance concerns, provide effective compliance oversight for Medicare obligations within the operational areas, and collaborate with key stakeholders.
Works very closely with the Manager, Regulatory Affairs (Medi-Cal), as well as other Managers within the Department to ensure alignment of priorities and division of responsibilities. Major Functions (Duties and Responsibilities)

1. Direct the day-to-day operations of the Regulatory Affairs (Medicare) Unit in the most effective manner to meet Plan, department, and unit objectives while ensuring quality and accuracy of the work. Implement standardized processes to maximize efficiency.
2. Oversee employment of Team Members, including recruitment, performance reviews, training, coaching, and development.
3. Direct, train, and educate Regulatory Affairs (Medicare) Unit Team Members to ensure the Medicare line of business is in compliance with the regulatory and contractual requirements.
4. Develop and implement the annual regulatory reporting calendar. Define metrics to measure the success of the regulatory reporting calendar. If the metrics identify an area of concern, escalate the issue and take corrective action, as needed.
5. Identify, direct and maintain Regulatory Affairs (Medicare) Unit metrics for the purpose of driving process improvements and efficiencies.
6. Assume a leadership role within the organization and oversee the interpretation of complex federal and state regulatory guidance. Guide the Regulatory Affairs Unit Team Members to serve as a resource to ensure that Business Units are provided with regulatory support to ensure compliance. This includes overseeing the interpretation, distribution, and implementation of Health Plan Memo Systems (HPMS), Dual Policy Letters (DPLs), etc.
7. Lead, guide, manage, and as appropriate attend in the participation of relevant committees and work groups, make presentations, prepare reports, data, or other materials. These may include, but are not limited to internal workgroups, workgroups convened by trade associations and workgroups convened by regulatory agencies.
8. Lead and oversee Regulatory Affairs Unit Team Member participation of various CMS regulatory agency calls and provide feedback to CMS Medicare Account Manager and other regulators from both Federal and State agencies as it relates to the Medicare line of business. Communicates outcomes, as appropriate, to relevant Business Units.
9. Identify potential Medicare risks, non-compliance and/or alleged violations within the Plan, and work with Compliance Audit & Oversight Unit to develop and implement department and unit corrective action plans (CAPs) for resolution. Partners with Business Units and provide guidance on how to avoid or prevent similar risks in the future.
10. Work closely with the Director of Compliance to support the CEO in fostering strong relationships with regulatory agencies. Oversee and manage the development of memos for the CEO and senior leadership to provide analysis on key emerging regulatory policy issues.
11. Serve as the primary liaison by establishing collaborative working relationships with CMS. Partners with Government Affairs, participating in selective collaborative relationships with the California Association of Health Plans (CAHP), Local Health Plans of California (LHPC), other trade associations, as well as Medi-Cal Managed Care Plans that are specific to Medicare Regulatory Affairs as needed.
12. Provides subject matter expertise and collaborates with Governmental Affairs when requested for responses to trade association inquiries specific to Medicare line of business.
13. Oversee and facilitate resolution of high-visibility, escalated requests and issues from CMS, DMHC and DHCS, including but not limited to Member and Provider cases. Supervisory Responsibilities Leader: Administers Hires, Terminations, and Performance Reviews Experience Qualifications

A minimum of five (5) years with managed care health plan or other relevant industry experience specific to CMS, DHCS/DMHC requirements. Direct experience interacting with regulatory agencies. Three (3) years supervisory experience. Preferred Experience

Experience in health care, Medicaid Managed Care Plans (MCPs), Medicare Advantage, Medicare Part D, Special Needs Plans (SNPs), and/or Medicare-Medicaid Plans (MMPs)/Cal MediConnect (CMC). Education Qualifications

Bachelor’s degree from an accredited institution required. Preferred Education

Master’s degree from an accredited institution preferred. Professional Certification

Certified in Healthcare Compliance (CHC) or commitment to obtain within one year of employment. Professional Licenses Drivers License Required Yes, must have a valid California Driver's License. Knowledge Requirement

Knowledge of principles and practices of managed care operations. Knowledge of Federal and State regulatory requirements related to Medi-Cal (Medicaid), Title 19 (USC)/Title 29 (USC and CFR), Title 22 (CCR), Title 28 (CCR), Title 42 (USC and CFR), CA WIC, and CA Health and Safety Code. Principles of project management. Principles of project management. Skills Requirement

Strong leadership and interpersonal skills. Excellent verbal and written communication skills. High level of analytical ability. Strong organizational skills. Microsoft Office programs including, but not limited to: Word; Excel; Power Point; Outlook. Abilities Requirement

Ability to understand, incorporate and demonstrate the mission, vision, and values of the Plan in behaviors, practices, and decisions. Ability to maintain a high level of diplomacy Ability to analyze complex regulatory requirements. Ability to be resourceful and independent in problem solving and self-direction. Ability to establish and maintain effective working relationships with internal departments and external agencies. Ability to embrace and champion change to accommodate evolving organizational and regulatory processes. Ability to work independently and collaboratively within a team environment. Ability to manage multiple projects with competing deadlines and changing priorities. Strong attention to detail. Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions

Major Functions (Duties and Responsibilites) Continued:
14. Determine the appropriate objectives, scope and methodology to ensure Plan compliance with the Medicare contract, and contract amendments. Review and understand Federal and State regulations, including but not limited to, CMS-published HPMS memos, Call Letters, Final Rules, and Office of the Insurance Commissioner requirements as well as other publications applicable to the various business lines for which IEHP may be rendering services.
15. Develop, review, and implement internal and external policies and procedures to ensure compliance with the Medicare contract, contract amendments, state and federal statutes and regulations, CMS published HPMS memos, Final Rules, DMHC Letters, DHCS Letters, policy transmittals, bulletins, and alerts. Review departmental policies and procedures annually and recommend changes as needed.
16. Lead Medicare compliance initiatives and ensures continuous support for the operational areas during planning, development, and implementation of those initiatives. Assure implementation has been completed.
17. Communicate to all levels of the Plan to ensure support, awareness, and effectiveness of compliance with the Medicare and Medi-Cal contract, contract amendments, Federal and State statutes and regulations, CMS memos, call letters, final rules, bulletins and alerts.
18. Cultivate an effective system for ensuring that relevant legislative, regulatory, enforcement and administrative developments and trends are reviewed promptly, analyzed carefully, and communicated to the relevant business leads in a constructive manner.
19. Organize and lead external audits from Federal regulatory agencies. Assure Team Members are prepared for the audit and any requested documents are delivered promptly. Act as the contact person during the audit.
20. Understand reported issues, document, and communicate them appropriately and identify mechanisms to prevent these issues from occurring in the future. Escalates, as warranted, instances of potential non-compliance to the Compliance Officer.
21. Partners with operational areas to ensure operational policies and procedures related to the Medicare line of business are compliant with Medicare regulatory and contractual requirements.
22. Acts in a compliant manner. Supports the IEHP Compliance Program through own actions as well as aligning the expectations of direct reports and unit team members job expectations with compliant practices. Allows time for employees to complete compliance training, supports enforcement of policies and procedures, and proactively engages with team to encourage reporting of incidents of noncompliance. Follows appropriate guidelines related to disciplinary action up to and including termination for violation of compliance expectations.

Working Conditions:
Occasional travel within the continental United States. Physical Requirements Keyboarding: Traditional - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: 10-Key - FREQUENTLY Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Sitting - CONSTANTLY Lighting - CONSTANTLY Indoors - FREQUENTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY

Starting Salary: $111,550.40 - $142,230.40
Pay rate will commensurate with experience

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region. With a provider network of more than 6,000 and a team of more than 2,000 employees, IEHP provides quality, accessible healthcare services to more than 1.2 million members. And our mission and core values help guide us in the development of innovative programs and the creation of an award winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and Make a Difference with us! IEHP offers a Competitive salary and a benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and retirement plan.

Job Type: Full-time

Source

https://www.indeed.com/jobs

Not sure if you qualify?

Uvaro is here to help you land great jobs like this one.

Upgrade your skills

Other Jobs

Uvaro

We’re on a mission to help the world’s professionals lead more fulfilling careers - from their first job to their last. At Uvaro, we’ve created a better way to help everyday people launch and grow successful and rewarding careers in tech. We’re growing quickly, and we’re looking for an Admissions Consultant to help us realize our vision. That’s where you come in! If you are looking to work in a fast-paced, highly collaborative environment that delivers life-changing impact every day, then we should talk. The Admissions Consultant is responsible for helping qualified applicants take ownership of their careers b y enrolling in Uvaro. This dynamic position requires the ability to run a best-in-class customer-centric sales cycle. If you are a dedicated problem-solver and are ready to make a huge impact in a growing company, we would love to hear from you! The successful candidate is: * Impact driven and motivated by helping others * An active and empathetic listener * A conversationalist with highly developed interpersonal skills * Effective at problem solving and solution selling * Excellent at motivating others * Highly adaptable * Proactive, self-motivated, and takes initiative * Self-disciplined  and works autonomously  * Performance-driven * A collaborative worker and team player In this role you’ll:  * Manage inbound leads process, and use tech stack (HubSpot, SalesLoft, Gong) to execute outbound calls/emails to program candidates * Understand Uvaro’s offerings and effectively map applicant needs and goals to our solutions * Nurture program candidates through a combination of rapid-response to inbound applications and reaching out through email, LinkedIn, and other platforms * Host regular information sessions with program candidates * Assess candidate qualifications using automated and manual tools, and by conducting phone and video interviews * Enroll qualified candidates into the Uvaro program by preparing enrollment packages, answering questions, assisting them with our ISA program manager, and ensuring all paperwork is completed in a timely manner prior to the program start date * Enter, update, and maintain daily activity and prospect information into Hubspot * Achieve and exceed monthly quotas and objectives * Work closely with sales and marketing team members to achieve company goals * Follow up on campaigns and provide detailed feedback on the success of each campaign * Ensure that all new leads are processed within agreed upon SLAs * Schedule meetings between program candidates and members of our other teams, such as Customer Excellence In the first six months you’ll: * Be fully integrated with our company * Be working independently * Be ramped on our tech stack, internal tools, and processes * Be running info sessions for potential candidates independently * Have already seen some of your program candidates graduate the program * Begin ramping on new tools as we upgrade our systems What we’re looking for: Don’t worry if you don’t have all the qualifications listed below - we are particularly interested in someone who adapts quickly to change and learns quickly, so if you don’t meet some of the criteria below but think you’re up for the challenge, please still reach out - we’d love to talk to you! * 1+ years of successful sales development experienced experience in B2B software or B2C services is a plus * Demonstrated strong written and verbal English communication skills  * Ability to work occasional evenings or weekends * Demonstrated success of achieving monthly goal attainment * Experience handling a sales pipeline in a CRM system (Salesforce, Hubspot) * Proven history of being adaptable and having a growth mindset What We’re Offering * Competitive compensation, health benefits, and equity * Flex work schedule and unlimited vacation policy * A remote-first work environment, and the opportunity to work with a close-knit, international team * The opportunity to get in early at a promising startup in the emerging field of tech-enabled education * A dedicated team with a values-driven culture, with a proven history of investing in individual growth and career development. * An unprecedented opportunity to grow your network by placing employees at virtually every high-growth tech company in North America If this opportunity excites you, and you believe you’re the right fit, we want to hear from you! At Uvaro, we understand the value of having a diverse and inclusive team. That’s why we believe in providing equal opportunity regardless of race, national or ethnic origin, colour, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability, and conviction. Please let us know if you require accommodation during the recruitment process.

 
Remote, or Waterl… / Remote
Uvaro

Do you feel inspired to identify and develop the next generation of diverse, talented sales professionals? Want to directly impact the growth of the SaaS industry at the same time? We’re on a mission to help the world’s professionals lead more fulfilling careers - from their first job to their last. At Uvaro, we’ve created a better way to help everyday people launch and grow successful and rewarding careers in tech. We’re growing quickly, and we’re looking for an experienced Sales Manager to help us realize our vision by leading our Admissions team. We are looking for a dedicated team lead to coach our sales team, ensure the team's targets are met, and work closely with the executive team. To be successful as a team lead, you should have excellent sales and mentorship skills, as well as exceptional organizational skills. If you are goal-driven, thrive in a fast-paced environment, and are ready to make a huge impact in a growing company, we would love to hear from you! In this role you’ll:  * Become a mentor to the sales team — nurture relationships with each representative in order to help them achieve their goals; provide proactive feedback and ongoing coaching to improve attainment * Lead by example — host regular information sessions with prospective students, manage inbound leads, and use sales engagement tools to execute a development cadence to potential students. * Work closely with other teams — pull reports and analyze data for your team and for management; collaborate with the marketing team to execute go-to-market campaigns; partner with the instruction team to ensure we’re signing up and onboarding potential students in a way that maximizes their chances of success. * Collaborate with senior management — jointly define sales and activity goals on a monthly, quarterly, and annual basis; refine and execute go-to-market strategies * Recruit and train new sales staff, assign specific tasks to members of the sales team, and monitor the team's sales performance. * Maintain data integrity — ensure you and your team enters, updates, and maintains daily activity and prospect information in our CRM and Sales Engagement platforms. * Achieve and exceed monthly quotas and objectives — achieve your own targets,  motivate the sales team, and create an atmosphere of shared success and healthy competition among the staff In this first 6 months you’ll: * Work closely with the leadership team to master the language we use to tell the Uvaro story * Master how to lead productive weekly sales kick-offs and close-outs * Leverage a best-in-class sales stack (including HubSpot, Gong, Kiite, SalesLoft, Vidyard, PandaDoc, Zoom and more) to reach out to your prospects * Help a high-performing team of sales professionals level-up their own sales acumen * Learn how to speak fluently about technology and education in your sales process What we’re looking for: Don’t worry if you don’t have all the qualifications listed below - we are particularly interested in someone who learns quickly, so if you don’t meet some of the criteria below but think you’re up for the challenge, please still reach out - we’d love to talk to you! * Experience successfully leading teams of sales or sales development professionals in technology or education businesses. * Someone with an insatiable curiosity, and the desire to dig into the data, processes, and systems we use to drive success. * Someone with a high EQ and history of demonstrating sound judgement, who is excellent at both motivating candidates to see the benefits Uvaro will bring to their careers, and at identifying potential barriers to candidates’ success in the Uvaro program * A strong sense of adaptability as things change quickly and you’ll need to keep up! * Someone who believes in the positive work Uvaro does to eliminate barriers in the tech industry and empower remarkable students * An enthusiastic team player, with a  desire to take initiative and work autonomously knowing you have the full support of the team * Experience working in a high-velocity sales environment using a CRM  (Salesforce, Hubspot, etc.) and a Sales Engagement platform (Outreach, SalesLoft, etc) * Excellent interpersonal skills and experience dealing directly with individual customers * Exceptional organizational and time management skills * Superb communication skills with ability to uncover underlying concerns or fears * Detail and results-oriented who works well under pressure What We’re Offering * Competitive compensation, health benefits, and equity * Flex work schedule and unlimited vacation policy * A remote-first work environment, and the opportunity to work with a close-knit, international team * The opportunity to get in early at a promising startup in the emerging field of tech-enabled education * A dedicated team with a values-driven culture, with a proven history of investing in individual growth and career development. * An unprecedented opportunity to grow your network by placing employees at virtually every high-growth tech company in North America If this opportunity excites you, and you believe you’re the right fit, we want to hear from you! At Uvaro, we understand the value of having a diverse and inclusive team. That’s why we believe in providing equal opportunity regardless of race, national or ethnic origin, colour, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability, and conviction. Please let us know if you require accommodation during the recruitment process.

 
Remote, or Waterl… / Remote
Uvaro

Sales Instructor We’re on a mission to help the world’s professionals lead more fulfilling careers - from their first job to their last. At Uvaro, we’ve created a better way to help everyday people launch and grow successful and rewarding careers in tech. We’re growing quickly, and we’re looking for an experienced instructor to help us realize our vision. That’s where you come in! If you are looking to work in a fast-paced, highly collaborative environment focused on the leading edge of education and technology, then we should talk. Course Instructors deliver Tech Sales programming in online, one-to-many, live, classroom settings, to customers around the world. They work closely with Career Instructors and across the Uvaro team and network to provide holistic industry skills development and career support. Through program delivery, guest instructor coordination, live role-playing, personal brand amplification, and live sales coaching, Course Instructors help customers stand out as Top Talent in the highly competitive Tech Sales industry. Course Instructors work collaboratively on Uvaro’s Customer Excellence team to set up our customers for success through the 12 week tech sales course, and then launch careers and play active roles as part of Uvaro’s Graduate community. Course Instructors work with customers in group and, from time-to-time, individual settings, to discuss career goals and will collaborate with Career Instructors to assist with coaching on hiring techniques based on industry experience. If you are a creative problem-solver, who thrives in a fast-paced environment, and are ready to make a huge impact in a growing company, we would love to hear from you! Don’t worry if you don’t have all the qualifications listed below - we are particularly interested in someone who adapts quickly to change and learns quickly. If you don’t meet some of the criteria below but think you’re up for the challenge, please still reach out - we’d love to talk to you!    In this role you will: *  Present course material live, in-class, 5 days/week, and facilitate group discussions to help develop understanding of material *  Review and adapt course material prior to class, and fold in new lessons to meet the unique needs of Uvaro’s customer cohorts * Homework management (deliver instruction for course assignments, collect course assignments, track submissions, evaluate submissions, and provide feedback in a timely manner) * Manage customer expectations and maintain record of  customer activity as it relates to course requirements and class performance in CRM tool(s). * Manage customer performance and address performance challenges proactively for customers who are not meeting Uvaro’s standards for program engagement * Leverage Uvaro’s, and your own network to coordinate Guest Speakers/Instructors in class as industry experts, to speak to novel concepts, and to address identified knowledge gaps in customer population *  Amplify customers’ success at every opportunity by supporting their personal brand development and growth efforts on online platforms and in online communities * While delivering the program, meet regularly with the Customer Excellence team to evaluate and adapt to customer needs * Engage in regular communication with customers (via Slack, email, Zoom, phone) outside of set class time to provide best-in-class customer support * Act as a key contributor to Slack community and Uvaro Graduate Network * Engage with network at industry and community events to build personal and Uvaro brand   What we are looking for: * Recent experience working as a B2B SaaS Sales Professional is required (3+ years preferred) *  Professional history as an adult learning instructor or teacher is an asset (2+ years preferred) * A history of conducting group presentations and facilitating group discussion in remote and online environments * Passionate about the Sales Industry * Exceptionally team-oriented *  Enthusiastic, has endurance, is consistently an energy giver in group settings *  An articulate and clear communicator * A strong group facilitator and presenter *  A compassionate and empathetic teacher, with knowledge of and/or experienced in adult learning theory and instruction *  Driven to help others develop new skills and transform their lives as a result *  Highly adaptable and resilient working in a highly variable environment *  Professional with an eye for detail and quality (communication consistency, presentation material) * A relationship builder whose network never seems to stop growing * Competent at helping others set goals * Capable of holding people accountable to their commitments and having expectation-levelling and class performance-related conversations * Self-disciplined, positive, and maintains a growth mindset *  Highly organized and punctual * Technically adept with standard business tools (ex. CRM, Slack, video communication tools, GSuite, Microsoft Office) * Experience coaching other professionals in a formal capacity is a bonus * Remote work experience is a bonus *  Start-up experience is a bonus *  Technical competence with business tools (CRM, GSuite, Slack, MicrosoftOffice, video communication tools) What We’re Offering: * A remote-first work environment, and the opportunity to work with a close-knit, international team * The opportunity to get in early at a promising start-up in the emerging field of tech-enabled education * A dedicated team with a values-driven culture, with a proven history of investing in individual growth and career development. *  An unprecedented opportunity to grow your network by placing employees at virtually every high-growth tech company in North America If this opportunity excites you, and you believe you’re the right fit, we want to hear from you! At Uvaro, we understand the value of having a diverse and inclusive team. That’s why we believe in providing equal opportunity regardless of race, national or ethnic origin, colour, religion, age, sex, sexual orientation, gender identity or expression, marital status, family status, genetic characteristics, disability, and conviction. Please let us know if you require accommodation during the recruitment process.

 
Remote, or Waterl… / Remote