Regulatory Consultant III Health Plan Regulatory and Exchange Operations Burbank, CA
Health Plan Regulatory and Exchange Operations (HPREO) is responsible for evaluating, interpreting, identifying and documenting business impacts and overseeing the implementation of the work as a result of Federal Commercial and Medicaid rules, regulations and laws across all functions and regions. This includes managing relationships and maintaining communications with stakeholders at all levels and management and/or oversight of ongoing operations required for participation on public exchanges.
TheHPREO Regulatory Consultant III will beresponsible for:
Evaluating, interpreting, identifying and documenting business impacts and overseeing the implementation of the work as a result of Federal Commercial and Medicaid rules, regulations and laws across all functions and regions. This includes managing relationships and maintaining communications with stakeholders at all levels and management and/or oversight of ongoing operations required for participation on public exchanges.
Analysis of Federal commercial and Medicaid rules, regulations, laws and guidance to understand the business impacts.
-Ensure ownership for implementation.
-Serve as the FFM Exchange lead by overseeing end to end administrative operations and responding to questions and issues from the regulator.
-Monitor all product and rate filings.
-Lead the QHP recertification Community of Practice and oversee successful QHP recertification in all jurisdictions.
-Responsible for project oversight relative to implementation of new Federal Commercial and Medicaid regulations, rules or laws.
-Manages, creates, and maintains client relationships.
-An understanding of business operations and business functions and how regulations impact business operations.
-May be responsible for oversight of complex business processes required for participation on public exchanges and communicate with stakeholders.
-Fosters comprehensive regulatory management through a series of activities to comply with all applicable regulations and statutes. Activities include:
-Planning: identifying regulatory accountabilities; identifying internal and external resources; developing regulatory analysis; participating on and may establish regulatory-related work groups; and managing external agency relations,
-Implementing: identifying regulatory requirements and conducting related analyses; creating or revising regulatory standards, policies, and procedures; monitoring regulatory adherence; and reporting on regulatory efforts and programs, and validating: reviewing regulatory programs and content,
-Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Communicates required changes, and leverages existing workgroups/etc. to facilitate required changes. Lead the development of operational policies and procedures.
- Minimum seven (7) years of health care experience or other applicable experience-health care operations, audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience.
- Bachelor's or clinical degree OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Thorough knowledge of health care, operations and related regulatory issues.
- Thorough knowledge of health care operations, regulatory policies, practices and systems and regional operational differences.
- Complete understanding of regulatory concepts.
- Full knowledge of health care industry practices and standards.
- Ability to draft and revise documents including analyses, and reports.
- Project management and/or consulting skills.
- Years spent in law school resulting in a law degree may count as applicable job experience.
Primary Location: California,Burbank,Marketing Sales Service and Admin 3100 Thornton
Scheduled Hours (1-40): 40
Working Days: Mon, Tue, Wed, Thu, Fri
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried, Non-Union, Exempt
Job Level: Individual Contributor
Job: Compliance / Privacy / Regulatory
Public Department Name: HPREO
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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