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    Manager,Compliance-Regulatory - Philadelphia, United States - Health Partners Plans

    Health Partners Plans
    Health Partners Plans Philadelphia, United States

    4 weeks ago

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    Description
    Why Choose Jefferson Health Plans?


    We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members.

    We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.


    While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

    Perks of JHP and why you will love it here:


    • Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
    • Flextime and Work-at-Home Options
    • Benefits & Wellness Program including generous Time Off
    • Impact on the communities we service
    We are seeking a talented and enthusiastic Manager Compliance - Regulatory to join our team


    Summary/Objective:


    Under the direction of the Director of Compliance, support the administration and oversight of Health Partners Plans' (HPP) compliance program.

    In close collaboration with all business units, and other compliance divisions, this position will demonstrate leadership and provide compliance strategy throughout HPP in the organization's efforts to achieve key objectives, maintain and improve compliance.

    This Manager of Compliance will assist with the oversight of Company compliance with contractual and regulatory obligations and State and Federal requirements related to health insurance and managed care.

    This role is responsible for managing a diverse range of compliance-related responsibilities associated with HPP's Medicare Advantage/Prescription Drug Program, Pennsylvania Medicaid, Pennsylvania CHIP lines of business.

    This position will assist the Director of Compliance by managing key functions including, but not limited to:


    • HPP's regulatory and sub-regulatory research and policy initiatives and oversight.
    • Administration and oversight of HPP's internal and delegated vendor compliance program.
    • HPP's adherence to the Medicare Communications and Marketing Guidelines, as it pertains to existing & potential Medicare enrollee materials.
    • HPP's Dual Special Needs Plan (DSNP) State Medicaid Agency Contract oversight
    • Medicare Part C & D Data Reporting requirements
    • Medicare Part C & D Product Development Compliance
    • Day to day operational issues, as needed
    As the Manager Compliance - Regulatory, your daily duties may include:


    • Serve as primary support to Director of Compliance with oversight and execution of HPP's Compliance Program.
    • Serve as a point-of-contact for questions and complaints from internal and external customers regarding business practices, Code of Conduct issues and corporate policies, including issues of a sensitive or confidential nature.
    • Investigate and analyze facts and circumstances alleged in compliance complaints and inquiries, and provides prompt, concise answers to inquiries, complaints, and/or concerns regarding the Code of Conduct, corporate policies, and the Compliance Program.
    • Act as liaison to HPP's internal business units for day-to-day assistance with regulatory operational compliance issues and concerns, including requests for information and/or clarification.
    • Manage a team of compliance professionals who ensure adequate compliance oversight of regulatory affairs.
    • Manage the regulatory and sub-regulatory guidance distribution, tracking and reporting process.
    • Oversee the coordination and implementation efforts of new regulatory and/ or contractual requirements impacting HPP.
    • Assist with overseeing the development of internal policies and procedures.
    • Serve as a business partner/consultant with operational areas and assist in maintaining an understanding of and compliance with regulatory requirements, as well as the organization's internal policies and procedures.
    • Serve as compliance support in the application, product development and bid submission process.
    • Oversee and manage the Medicare Part C & D Data Reporting requirements, including assisting with Data Validation Audit related needs.
    • Ensure ongoing adherence with contractual provisions and reporting requirements set forth in our Pennsylvania D-SNP State Medicaid Agency Contract.
    Qualifications


    • Bachelor's Degree or significant experience with Healthcare compliance. Compliance professional certifications are preferred but not required.

    Skills, We Value:

    • Must be highly organized, analytical and detailed oriented.
    • Excellent interpersonal skills; must be an effective public speaker, presenter, and communicator with diplomacy and tact.
    • Strong oral and written communication skills.
    • Strong facilitation, collaboration and teamwork skills with the ability to build cross-functional partnerships to drive results.
    • Must be able to facilitate meetings and achieve consensus regarding work plans and responsibilities.
    • Demonstrate ability to understand and interpret complex regulations.
    • Working experience with PC based applications such as Excel, PowerPoint, Word.
    • Excellent time management skills.
    • Strong conflict resolution skills.
    • Process and project management ability.
    Other details


    • Pay Type Salary
    Apply Now


    • Philadelphia, PA, USA
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