Incumbent leads the State Regulatory Affairs department and responsible for developing and executing the Medicaid Regulatory Affairs strategy, focused on publicly funded healthcare programs. Provides guidance, oversight and support to Regulatory Affairs teams with respect to contract administration and account management. Provides strategic guidance from a regulatory perspective to the market leader, COO and/or leadership team. Partners with state Medicaid agency to ensure compliance and effective partnership.
- Identifies, compiles and aggregates regulatory and operational issues across markets to manage risk. Partners with markets on resolutions through expertise and lessons learned.
- Makes timely and effective decisions using data and takes a fact-based approach to problem-solving, while understanding the limits of data to make and support decisions.
- Establishes the Medicaid Regulatory Affairs strategy and oversees contract administration activities in markets.
- Manages and supports audits and implementations to ensure regulatory requirements are satisfied.
- In partnership with Corporate Compliance, develops procedures, toolkits and reports and monitors contractually required deliverables, including but not limited to, regulatory reports and performance metrics.
- Develops procedures and toolkits for Account Management Plans and monitors adherence with corporate processes.
- Directs and manages a team of associates responsible for supporting Medicaid Regulatory Affairs initiatives and teams.
- Supports development and implementation of Regulatory Affairs in new markets.
- Develops and manages department budget.
- Performs special projects as needed.
This position is contingent upon the bid award in the state of New Mexico to WellCare Health Plans, Inc.M1Education:
- A Bachelor's Degree in business administration or related field required.
- A Master's Degree in public policy, public health, political science, health administration or related field preferred.
- 10 years of experience in managed health care or health care consulting required.
- 5 years of management experience required.
- Demonstrated leadership skills.
- Ability to lead/manage others.
- Demonstrated facilitative skills.
- In-depth knowledge of government programs and the managed care industry and experience leading and managing regulatory affairs programs through teamwork, collaboration and open communication.
- Intermediate proficiency in Microsoft Outlook, Word, Excel, PowerPoint, Project, Access, and Visio
- Knowledge of and/or ability to utilize a budgetary decision application.