Regulatory Operations Manager (Remote)

RESP & QUALIFICATIONS

PURPOSE This position is accountable for the oversight of the Mandates Regulatory Operations and Reporting team. Key responsibilities include gathering, analyzing, and disseminating key sources of information on Association, Federal, State, and Local legislation, as well as the identification and definition of requirements for mandates compliance. This position will collaborate with Public Policy and Government Affairs (PPGA), Legal, Business, and Enterprise Project Management Office (EPMO) to ensure that all mandate requirements are reviewed and agreed upon by stakeholders and implemented. This position is also accountable for overseeing, providing analysis and recommendations on mandates for strategic decision making both internally and externally, and for ensuring support of the companys business objectives and compliance.

ESSENTIAL FUNCTIONS

• Accountable for the tracking, analysis, and evaluation of new local, state, and federal regulations and Association mandates.
• Maintains a comprehensive legislative tracker and monitors regulatory guidelines.
• For all mandates with CareFirst impact, determines if implementation is required and confirms whether it is for compliance or informational distribution only.
• Tracks the achievement of CareFirst compliance status timelines and integrates with EPMO project teams for execution of mandate implementation projects.
• Works with Legal, Business, and EPMO to ensure project implementation activities result in compliance with mandates that are operationally plausible.
• Manages annual regulatory operations projects that do not have a single business owner, such as MLR and Creditable Coverage Notification. Develops, maintains, and oversees processes for tracking and reporting on these projects, ensuring timely and accurate completion.
• Accountable for staffing activities including recruitment, interviewing, selection, and hiring qualified staff. Provides oversight and direction to the employees in accordance with the organizations policies and procedures.
• Responsible for coaching, mentoring, and developing staff, including overseeing new employee onboarding and providing career development planning and opportunities, including delegating as appropriate to direct reports.
• Responsible for performance management and completion of annual performance evaluations. Provides timely performance feedback throughout the year via employee recognition, rewards, and disciplinary action as appropriate. Maintains transparent communication and appropriately communicates organizational information through department meetings, one-on-one meetings, and appropriate email, IM, and regular interpersonal communication.
• Accountable for reporting and documentation. Establishes and maintains auditable business processes for the efficient collection and submission of data required by regulatory bodies. Oversees the creation and submission of annual and ad hoc reports, ensuring that all data is accurately compiled and legally vetted.
• Responsible for cross-departmental collaboration. Works closely with PPGA, Legal, EPMO, Compliance, and other departments to establish and maintain effective processes for the handoff and execution of regulatory work. Serves as a liaison between these departments to facilitate communication and collaboration.
• Accountable for providing the VP Regulatory Operations and other business areas with relevant information for the purpose of strategic decision making by providing analysis and subject matter expertise on mandates.

SUPERVISORY RESPONSIBILITY This position manages people.

QUALIFICATIONS Education

• Bachelors Degree in Business or related field.
• OR in lieu of a Bachelors degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience

• 5 years in an IT and/or business role in a health insurance or regulatory compliance environment.
• 1 year supervisory or demonstrated progressive leadership experience.

Preferred Qualifications

• Understanding of federal, state, and local legislative and regulatory processes, public policy analysis.
• Comprehensive understanding of the healthcare payor industry, insurance products, and regulation.
• Expansive knowledge of CareFirst operations.

Knowledge, Skills, and Abilities (KSAs)

• Strong verbal and written communication skills along with problem-solving, negotiation, and decision-making skills to influence management and internal/external partners.
• Demonstrated leadership abilities and effectiveness in matrix management. Strong management and team building skills.
• Excellent business analysis and process improvement skills.
• Ability to work well with all levels of management, including senior and executive levels.

SALARY RANGE 112,960 - 209,682

SALARY RANGE DISCLAIMER The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as, but not limited to, the scope and responsibilities of the position, the candidates work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range as compensation decisions depend on each cases facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans. All benefits/incentives are subject to eligibility requirements.

DEPARTMENT Corporate Governance

EQUAL EMPLOYMENT OPPORTUNITY CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran, or disabled status, or genetic information.

WHERE TO APPLY Please visit our website to apply: www.carefirst.com/careers

FEDERAL DISCLOSURE Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key, and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

SPONSORSHIP IN US Must be eligible to work in the U.S. without Sponsorship.

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