Senior Director of Regulatory Affairs

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that healthcare is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work proud of what you do every day.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of the Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products, including New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, and more. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth’s network includes over 27,000 primary care providers, specialists, and participating clinics. For over 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest lives.

Position Overview

As a Senior Director of Regulatory Affairs, you will manage a team of regulatory professionals who analyze new regulatory requirements, work closely with the business to understand the impact and obligations of those requirements, and support the business in understanding the evolving regulatory landscape. With wide latitude for individual initiative and decision-making, the Senior Director of Regulatory Affairs provides leadership and oversight of the Regulatory Affairs unit relating to all products offered by MetroPlusHealth, as well as other projects assigned by Executive Leadership.

Job Description

• Provide leadership and expertise in the analysis and interpretation of complex state and federal laws across the MetroPlusHealth portfolio.
• Direct and supervise the Regulatory Affairs unit to ensure dissemination of all new regulations and product contract updates throughout the organization.
• Provide regulatory support by interpreting regulations and seeking clarification from regulatory bodies, while proactively communicating with internal divisions about key regulatory issues.
• Lead communication improvements to better inform the organization about new legislation and regulatory agency directives.
• Assist Compliance teams in understanding federal, state, and local regulations and product contract requirements.
• Establish protocols for oversight of new rules/requirements, including service and population inclusions in various insurance products.
• Develop and advise on communications to inform stakeholders of regulatory changes and impact for stronger compliance.
• Collaborate with Compliance on managing and responding to external audits and surveys related to NY State product offerings, including NYS Department of Health Article 44 audits.
• Engage with Local, State, and Federal agencies as well as trade associations.
• Oversee and manage workflows for timely resolution of Regulatory Complaints and Fair Hearings.
• Interface with internal departments (sales, operations, product, pharmacy, communications, government affairs, legal) and external clients on regulatory matters.
• Demonstrate a strategic mindset to deliver value to business teams.
• Support and coordinate with business leaders on regulatory changes to drive achievement of business goals and clarify regulatory expectations.
• Anticipate policy and regulatory trends and coordinate advocacy strategies with the government relations team.
• Cultivate collaborative relationships with business clients, regulators, and partners.
• Drive team success, engagement, and development to resolve complex business issues.

Minimum Qualifications

• Bachelor’s degree required
• Minimum ten years of experience with Medicare and Medicaid laws/regulations, including senior roles in managed care compliance or regulatory departments, with detailed knowledge of rules governing managed care health plans.
• Thorough knowledge of health law and policy, compliance programs, and health plan regulations.
• Knowledge of business administration principles, management functions, and the structure of health plan departments.
• Supervisory and relationship-building experience across business groups internally and externally.

Professional Competencies

• Collaboration and strategic thinking ability
• Management of multiple projects to handle own workload
• Excellent oral, written, and presentation skills, with strong conceptual and analytical abilities to review and articulate corporate objectives and federal regulations.
• Integrity and confidentiality
• Experience with legal research applications (e.g., Lexis)
• Strong communication skills, both verbal and written, for complex information
• Demonstrated abilities in:
  • Communicating with Others
  • Managing Ambiguity and Uncertainty
  • Critical Thinking
  • Resilience and Resourcefulness
  • Influencing Others
  • Organizational Agility
  • Demonstrating Presence
  • Developing Others

#LI-Hybrid

Learn more here