Bachelor's Degree in a related field or equivalent experience required
4-6 years of relevant experience preferred
Strong understanding of Medicare Advantage and Health Exchange regulations
Excellent interpersonal and communication skills
Ability to manage projects and monitor compliance effectively
Responsibilities
Lead self and others in alignment with OneCHRISTUS Competencies
Research and review laws and regulations for compliance
Monitor Health Plan progress on risk assessments and audit findings
Analyze risk-related trends for the Compliance Committee
Conduct ongoing internal audits based on risk levels
Support consistent compliance processes in health plan operations
Develop educational materials and provide specialized training
Benefits
Full-time work schedule from 8AM to 5PM, Monday to Friday
Opportunity to work closely with senior leadership
Engagement in meaningful compliance initiatives
Professional development through cross-training opportunities
Involvement in external compliance audits and regulatory guidance
Full Job Description
Summary:
The Program Manager Health Plans Regulatory Affairs role is to assist in the implementation and maintenance of the CHRISTUS Health Compliance Program. This job assists the Regulatory Affairs team in the execution of established work priorities and plans, management, and monitoring of operational compliance related tasks. These tasks are to include internal auditing and monitoring activities, external audit coordination, and regulatory training and education.
Responsibilities:
Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Review and research laws and regulations both on a reactive and proactive basis to ensure an effective and accurate response to legal and regulatory compliance for Medicare Advantage and Health Exchange lines of business.
Monitors Health Plan progress in resolution of issues identified through the Risk Assessment and Monitoring Work Plan and internal and external audit findings.
Analyze and periodically report on risk-related trends to the Compliance Committee to ensure organizational awareness of potential noncompliance.
Perform ongoing internal monitoring/audits based on risk level.
Support implementation of consistent processes to enhance compliance within day-to-day health plan operations.
Provide specialized education and development of materials as requested.
Follow up with Action items necessary related to various audit requests and compliance related issues.
Work with the regulatory affairs team to develop streamlined approaches between lines of business.
Cross-train the regulatory affairs team on compliance related tasks to ensure operational compliance goals are met.
Excellent interpersonal skills with regular interaction and communication with the Senior Leadership team and other associates within the organization.
Ability to facilitate the resolution of issues and concerns that create barriers to a high-performing team and work environment.
Ability to manage project/monitoring work plans for achieving project goals and objectives.
Coordinates assigned projects, including monitoring projects to present to leadership and regulatory bodies.
Serves as Project Manager on external compliance audits conducted by regulatory bodies.
Serves as a resource in regulatory guidance for Health Exchange and Medicare Lines of Business.
Performs other duties as assigned.
Job Requirements:
Education/Skills
Bachelor's Degree in Related Field of Study and or equivalent years of work experience required
Experience
4 - 6 years of related experience preferred
Licenses, Registrations, or Certifications
None required
In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.
