Manager, Regulatory Integrity

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Southfield, MI


<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p>

keywords: position summary,analysis,management,consulting,leadership,critical thinking,quality assurance,experience,skills

Mid-level Manager

Competitive Compensation and Benefits Package

Overview: The Regulatory Services team monitors changes in the regulatory environment, communicates changes with the business, and assists change management by consulting with the business on regulatory matters.<br /><br />The Manager, Regulatory Integrity is directly responsible for the team&rsquo;s success and operations. The manager oversees the team&rsquo;s tasks, ensuring departmental processes are conducted timely and accurately, with a high standard of quality, and ensuring departmental goals are met. The manager serves as a liaison, advocate, and information resource for the business. The manager applies regulatory experience to articulate regulatory changes, compliance concerns, risk assessments, and potential courses of action to customers.<br /><br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp; Travel may be required.</p>
Responsibilities: <ul> <li>Manager, Regulatory Integrity will manage Advantasure&rsquo;s Regulatory corporate responsibilities for: <ul> <li>Monitoring Medicare Advantage and Commercial market regulations</li> <li>Analysis of federal guidance, with a focus on risk adjustment and quality</li> <li>Supporting implementation activities with regulatory input</li> </ul> </li> <li>Will work closely with Advantasure&rsquo;s business areas to ensure they receive analysis of new regulations in a timely, effective manner to support business implementation and strategic decision making</li> <li>Lead and manage the responsibilities of a small team in a dynamic environment</li> <li>Partner and collaborate with stakeholders across the enterprise</li> <li><em>Manage the day-to-day operations and activities of the Regulatory Services Team. Set priorities, evaluate performance and ensure the best utilization of talent, utilize staff and facilities.</em></li> </ul> <ul> <li>Identify staffing needs and ensure appropriate levels of service.</li> <li>Evaluate training needs, develop and implement training plans.</li> <li>Mentor and coach employees, conduct performance reviews, provide guidance and advice when necessary and encourage/motivate employees in their daily efforts and professional development.</li> </ul> <ul> <li>Monitor changes to states laws and regulations. Analyze impacts and make recommendations to the business Monitor and articulate regulatory changes to the business.</li> <li>Coordinate with and advise the business on opportunities to improve regulatory compliance.</li> <li>Articulate and advocate courses of action that balance the business&rsquo;s risk posture and desire for best outcomes.</li> <li>Advise the business on potential courses of action in regulatory matters, acting in a consultative capacity and as an advocate for the business.</li> </ul> <ul> <li>Act with personal and professional integrity and objectivity.</li> </ul> <ul> <li>Responsibility for balancing workload to optimize the effectiveness of the department.</li> </ul> <br /> <p><strong>DISCRETION EXERCISED:</strong></p> <p>Directly manages staff in accordance with company policies and applicable federal and state laws. Responsibilities include effectively interviewing, hiring, terminating, and training employees; resource and task planning, assigning and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.</p>
Requirements: <p><strong>EXPERIENCE:</strong></p> <p>Ten years experience in a regulatory services environment with demonstrated technical experience that provides the necessary knowledge, skills and abilities.&nbsp; Three years supervisory or leadership experience.</p> <p>&nbsp;</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Must demonstrate leadership ability and team building skills to effectively supervise staff and interact with all levels of management.</li> <li>Experience with federal regulatory analysis or working in the federal regulatory or legislative environment</li> <li>Experience with Medicare Advantage and the Affordable Care Act</li> <li>Experience managing processes or project management</li> <li>Experience with Risk Adjustment (MA, Commercial, or Medicaid) business is a plus</li> </ul> <ul> <li>Ability to work with and empower others on a collaborative basis to ensure success of unit team.</li> </ul> <ul> <li>Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.</li> <li>Ability to establish workflows, manages multiple projects, and meets necessary deadlines.</li> <li>Ability to interpret and analyze relevant insurance laws/regulations.</li> <li>Demonstrated leadership ability.</li> <li>Ability to interact with others to build consensus and get decisions implemented.</li> <li>Ability to apply the principles of logical thinking to define problems, collects data, establish facts and draw conclusions.</li> <li>Ability to comprehend the consequences of various problem situations and address them, or refer them for appropriate decision-making.</li> <li>Excellent organizational skills and the ability to prioritize tasks.</li> <li>Ability to maintain confidentiality.</li> <li>Ability to perform other assignments at locations outside the office.</li> </ul>