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    Director, Clinical Operations Regulatory Support - New York, United States - Healthfirst

    Healthfirst
    Healthfirst New York, United States

    1 week ago

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    Description

    Responsible for developing and implementing strategies to ensure clinical compliance with regulatory requirements. Primary duties include regulatory oversight, regulatory support, regulatory change management, and management of policy documentation. The Director strengthens Clinical Operations' regulatory position by ensuring support for regulatory scope change implementations, leading audit support and audit readiness functions, and facilitating corrective action plans (CAPs).

    • Leads department efforts related to audit preparation, responses, and corrective action plans surrounding quality, Model of Care, and any other form of information requested from the team that could possibly have regulatory implications
    • Monitors changes in regulations and ensures the organization's policies and procedures are updated
    • Ensures that Clinical Operations policies undergo annual review to include ensuring any required updates and approvals are complete, accurate, and timely
    • Oversees regulatory submissions and reports to agencies e.g. NYS DOH, CMS, etc.
    • Collaborates with stakeholders across the organization to establish timelines and obtain required information in support of regulatory actions
    • Oversees regulatory implementation efforts
    • Communicates with regulatory agencies and other external organizations
    • Ensures that Healthfirst meets requirements for all lines of business by developing requirements, documenting the activities that meet the requirements, and collaborating with stakeholders to close gaps as needed
    • Manages SNP Model of Care Committee which includes implementing and maintaining a committee structure, working with stakeholders to prepare for committee meetings, and managing committee membership
    • Develops and maintains departmental work plans and policies & procedures to ensure Healthfirst meets all regulatory requirements
    • Supervises the performance of direct reports and provides training and development opportunities; manages and holds team accountable for workload; conducts interviews, handles employee relations, and evaluates performance to develop a high functioning team
    • Additional duties as assigned or needed
    Minimum Qualifications:
    • Bachelor's degree from an accredited institution or equivalent work experience
    • Experience leading/supporting regulatory activities/audits
    Preferred Qualifications:
    • Master's degree from an accredited institution
    • Previous experience in managing staff and developing staff
    • Expertise reading and interpreting regulatory requirements for healthcare/managed care organizations
    • Expertise developing work plans and organizing work to execute against timelines
    • Work experience requiring effective communication with internal and external stakeholders in a variety of formats, both written (i.e., Word documents, Excel spreadsheets, PowerPoint presentations) and oral (i.e., conference calls, face-to-face meetings and presentations)
    Compliance & Regulatory Responsibilities: See Above

    License/Certification: N/A

    WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

    If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

    EEO Law Poster and Supplement

    All hiring and recruitment at Healthfirst is transacted with a valid "" email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not , or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

    Hiring Range:
    • Greater New York City Area (NY, NJ, CT residents): $150,800 - $230,690
    • All Other Locations (within approved locations): $124,400 - $190,315
    As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

    In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.     The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
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