Regulatory Affairs Director - Hybrid (Bronx Office) at CareSource Management Services LLC — Bronx, NY

Job Summary:

The Regulatory Affairs Director is responsible for leading activities of the Regulatory Affairs Department, including contracts, compliance, surveys, audits, investigations, reporting, plan development and renewal, credentialing, Fraud, Waste & Abuse Special Investigations, provider network and relations, regulatory updates and compliance matters.

Essential Functions:

• Review, draft, negotiate and process agreements and amendments in accordance with organization guidelines.
• Lead projects involving the collection and submission of data and information related to government audits, surveys and requests.
• Oversee provider contracting, including letters of agreement and associated follow-up.
• Review, disseminate and handle fair hearing (FH) notices and decisions; manage FH calendar; attend FHs as needed, review and handle communications with OTDA and submit reports; prepare status reports and updates on cases.
• Lead activities of the Special Investigation Unit (SIU), including SIU reporting and internal investigations.
• Review and update applicable HIPAA policies and procedures in compliance with HIPAA laws and regulations.
• Review OIG/OMIG requirements and best practices for compliance and program integrity; review and update compliance materials, including manuals, policies and procedures, and handbooks, to comply with regulatory requirements.
• Make recommendations based on best practices and draft policies and procedures.
• Review DOH and CMS plan contracts and edit plan documents in compliance with contract requirements.
• Review, clarify and disseminate CMS memos and DOH guidance; keep abreast of related laws, regulations and official guidance.
• Coordinate document and requests of outside counsel for litigation matters.
• Oversee provider credentialing process and related activities.
• Draft policies, procedures, manuals, plan and member materials.
• Provide guidance and direction to Department staff.
• Perform any other job related duties as requested.

Education and Experience:

• Juris Doctor (J.D) degree from an accredited college/university required
• Five (5) years experience with Medicare and NY Medicaid managed care contracting and compliance required
• Previous leadership experience preferred

Competencies, Knowledge and Skills:

• Strong customer service and team orientation
• Ability to adapt to a changing environment to achieve results
• Demonstrated leadership skills
• Skilled in organization, workflow analyses and management of details
• Advanced Microsoft Office skills, including Word
• Strong editing and proofreading skills
• Excellent written and oral communications skills
• Excellent time/project management and prioritization skills
• Ability to excel in fluid, dynamic environment

Licensure and Certification:

• Current, unrestricted Attorney license required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Ability to travel as required by the needs of the department.
• 2 Days work from home; 3 days work in Bronx office each week

Compensation Range:

$135,600.00 - $237,400.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

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