Participates in and supports companywide corporate ethics and compliance programs, the Trust Program, and the ongoing review and approval of all marketing materials.
- Performs comprehensive, complex regulatory analyses, including the review, summarization and dissemination of key regulatory updates and changes.
- Drives policy and procedure process, including the design, review, cataloging, dissemination and annual updating of corporate policies and procedures.
- Coordinates review and investigation of Trust Program reports.
- Coordinates site visits by Federal and State regulators.
- Develops regulatory process flows, including the documentation of departmental processes, report generation, and process improvement
- Provides project leadership for compliance-related audits, including the review of departmental documents, interview of departmental staff, summarizing results and implementing recommendations.
- Supports the design, development and implementation of the Regulatory database ensuring all key departmental processes are captured in the database for tracking and trending purposes.
- Supports management of the regulatory communications process ensuring all regulatory communications/updates are received, summarized, catalogued, disseminated and acted upon.
- Coordinates filing of regulatory forms, reports, etc. and provides guidance to other departments in understanding and complying with regulatory requirements.
- Tracks all issues referred to the Regulatory Affairs Department up to and including resolution.
- Represents the health plan at federal, state, and local government meetings.
This position is contingent upon the bid award in the state of Illinois to WellCare Health Plans, Inc.
Candidate Education / Experience:
- BA/BS Degree
- 7 years experience in Managed Care/Health Insurance or a Master's Degree in Business, Public Health, Health Care Administration, or related field.
- State or Federal Managed Care Compliance experience.
- Solid knowledge of Microsoft Outlook, Excel, Word, and Access.