Senior Regulatory Implementation Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Spearhead the execution of new and updated regulatory mandates affecting Medicare Advantage operations.

• Convert intricate regulatory directives into practical implementation strategies and operational necessities.

• Oversee organization-wide preparatory measures for regulatory and compliance projects.

• Create project blueprints, including milestones, dependencies, and implementation schedules.

• Evaluate operational implications across various domains such as enrollment, claims, grievances and appeals, member services, pharmacy, provider operations, care management, quality and Stars, sales and marketing, risk adjustment, and technology.

• Collaborate with cross-functional business, operational, and technology teams.

• Facilitate working groups for implementation and governance meetings.

• Manage project risks, dependencies, issues, and escalations effectively.

• Formulate and carry out regulatory readiness strategies.

• Revise policies, procedures, workflows, and job aids as needed.

• Oversee business process redesign and operational modifications.

• Assist in training and communication efforts.

• Coordinate technology upgrades, system configurations, and vendor modifications.

• Supervise UAT, Business Validation Testing, Readiness Testing, and Production Validation processes.

• Aid in corrective action strategies arising from CMS audits and compliance assessments.

• Keep implementation documentation and audit trails up to date.

• Manage regulatory implementation alongside third-party vendors and delegated entities.

• Generate executive implementation status reports and dashboards.

• Report progress, risks, and readiness evaluations to leadership.

• Provide recommendations for go-live readiness and risk mitigation.

⛳️ Requirements

• A minimum of five (5) years’ experience in healthcare operations, compliance, regulatory affairs, implementation management, project management, or Medicare Advantage operations.

• Bachelor's degree in Business Administration, Healthcare Administration, Information Systems, Project Management, or a related field.

• Proven experience in managing complex, cross-functional projects involving regulatory or compliance mandates.

• Comprehensive understanding of project management principles and implementation methodologies.

• Excellent stakeholder management and communication capabilities.

• Proficient in interpreting and operationalizing regulatory requirements.

• Strong organizational and analytical abilities.

• Capability to perform essential physical functions as described in the posting, with reasonable accommodations available.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance plans.

• Retirement savings plan with employer matching.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and career advancement.