Regulatory Specialist

🔥 2 minutes ago

🌾 Nebraska, New Hampshire, +2 more states – Remote

🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🗽 New York – Remote 🗿 South Dakota – Remote

💵 $68.9k - $99.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Healthfirst

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1993

⚕️ Healthcare Insurance

💸 Finance

Healthcare Insurance • Finance • Medicare

Healthfirst is a health insurance provider dedicated to helping New Yorkers access affordable health coverage for individuals and families. With over 30 years of experience, Healthfirst offers a range of plans including Medicaid managed care, Medicare Advantage, long-term care, and essential health plans. The company focuses on providing quality healthcare options, comprehensive benefits, and support to ensure members can maintain their health and well-being.

📋 Description

• Responsible for promoting compliance with regulatory requirements with Healthfirst's different departments • Meets with the Regulatory department to organize pre-survey deliverables and conduct reviews of materials • Interacts with and represents the business unit • Responds to auditor requests and audits outcome results • Identifies organizational risks and helps implement process improvements • Manages, coordinates, and participates in the implementation of contract changes for all lines of business • Ensures that all process and contract changes are reflected in departmental policies and procedures • Monitors all Utilization Management/Care Management/Appeals & Grievances corrective action plans (CAPs) through completion • Assists in accreditation submissions, regulatory surveys, and internal audits • Provides support to Pharmacy Department related to regulatory implementation efforts

🎯 Requirements

• High School Diploma or GED • Bachelor's degree from an accredited institution (preferred) • Previous relevant compliance experience • Proficiency with Microsoft systems like Outlook, Excel, and Word • Strong knowledge of CMS and/or New York State DOH regulations • Compliance experience within a managed care environment • Working knowledge of project management • Intermediate MS Word, Excel, PowerPoint, Adobe Acrobat and corporate email systems • Ability to build and maintain positive relationships with cross-functional teams and interact with all levels of management • Time management, critical/creative thinking, project management, communication, and problem-solving skills

🏖️ Benefits

• medical, dental and vision coverage • incentive and recognition programs • life insurance • 401k contributions