Job Information
Healthfirst Director, Clinical Operations Regulatory Support in Hybrid, New York
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 organizations 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
PreferredQualifications:
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 mental or physical disability, 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.