Dir, Regulatory Affairs – GP

19 May, 2020


Dir, Regulatory Affairs – GP

Horizon BCBSNJ
Hopewell, NJ

Job Summary:

Directs oversight of all Government Program Division managed care contracts with the New Jersey Department of Human Services, including Medicaid, Managed Long Term Care, and Medicare. Responsibilities include coordination of state and federal legislative and regulatory activities for the Government Programs Division and serves as HNJH contact with the Department of Human Services, Department of Health, and Department of Banking and Insurance, and other related agencies for all regulatory issues. Position has supervisory responsibilities. This position is the key relationship builder with not only Medicaid related government agencies, but outside stakeholders and influencers in the community.

This position reports to: Chief Medicaid Officer, Vice President Medicaid Horizon NJ Health, Government Programs, Horizon BCBSNJ

  • Drive Business results by focusing on desired outcomes and how best to achieve them. Looks for opportunities move projects forward. Identifies when analysis and discussion have served their purpose and assist the organization in moving into action. Responds to setbacks with renewed and increased efforts.
  • Work in close partnership with Medical Management, Finance, Quality Management, Corporate Compliance, Legal and Government Affairs Areas, Business Services and Operations, and Provider Contracting and Servicing to ensure State reimbursement adequacy and inclusion of HNJH strategic initiatives in State contracts.
  • Cultivate, drive and maintain critical strategic business partnerships with regulatory agencies (Department of Human Services, Department of Banking & Insurance, Department of Health, Department of Children-s & Families, and CMS), industry associations (Blue Cross Blue Shield Association, Association for Community Affiliated Plans, Medicaid Health Plans of America, and NJ Association of Health Plans), and other external stakeholders (ARC of NJ, NJ Hospital Association, Home Health Association, Health Care Association of NJ).
  • Provide the leadership, management and vision necessary to ensure that the Government programs Division has the proper operational controls to effectively sustain and grow the Medicaid program and to ensure its operating efficiency and financial strength.
  • Assist the CEO Horizon NJ Health, Senior Vice President and Chief Medicaid Officer, Vice President Medicaid, Government Programs, Horizon BCBSNJ to guide and develop strategic initiatives to ensure operational objective are met. Researches and develops recommendations for the solution of complex operational, financial, and politically sensitive issues.
  • Leverage knowledge, experience, and NJ Medicaid intelligence data to assist in development of member enrollment projections and forecasts for the Government Programs Division programs.
  • Champion process/ workflow improvements within or across departments/divisions. Manages projects and issues across departmental and divisional lines to facilitate timely resolution. Takes personal responsibility for the quality and timeliness of work, and achieves results with little oversight.
  • Receives and oversees responses to all complaints received from the DOBI, DOH, State and Congressional legislators and assist in obtaining approval for provider contracts and certificates of Authority modifications from the DHS and DOBI.
  • Assists other departments in understanding and complying with regulatory requirements by researching regulations and assisting as needed in developing procedures to comply with, and draft responses to, queries from regulatory agencies.
  • Direct staff to ensure overall client satisfaction and appropriate level of service delivery.


  • Requires a Bachelor’s Degree from an accredited college or university.
  • An advanced and/or law degree is preferred.
  • Minimum 10 years experience with regulatory activities in the health care field.
  • Minimum 10 years experience in Health Insurance and knowledge of Health Care issues.
  • Requires a minimum of 8-10 years of experience in managed healthcare or related industry.
  • Requires a record of progressively responsible management and supervisory experience.
  • Requires minimum of 3 to 10 years of supervisory experience.


  • Detailed knowledge and experience (20 years) of the New Jersey Legislature and Regulatory process.
  • Requires knowledge of state and federal regulations related to the managed care industry, preferably in the areas of government programs.
  • Requires knowledge of the regulatory environment and requirements.
  • Prefer solid knowledge of Horizon NJ Health-s operations.

Skills and Abilities:

  • Requires excellent verbal and written communication skills.
  • Requires strong leadership and management skills.
  • Ability to achieve results through others in a decentralized organization without formal reporting relationships.
  • Ability to manage resources efficiently.
  • Ability to facilitate closure.
  • Decision making ability.
  • Ability to maximize use of available technologies including use of a computer and applicable software.
  • Ability to manage multiple projects and tasks.
  • Good analysis skills.
  • Excellent interpersonal skills and ability to build consensus.

Travel (If Applicable):

  • Limited travel.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.

Learn more here

Job posted: 2020-05-19