Senior Regulatory Implementation Manager

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $113.3k - $170k / year

⏰ Full Time

🟠 Senior

🛠️ Implementation Specialist

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Lead implementation of new and revised regulatory requirements impacting Medicare Advantage operations • Translate complex regulatory guidance into actionable implementation plans and operational requirements • Coordinate enterprise-wide readiness efforts for regulatory and compliance initiatives • Develop project plans, milestones, dependencies, and implementation timelines • Assess operational impacts across enrollment, claims, grievances and appeals, member services, pharmacy, provider operations, care management, quality and Stars, sales and marketing, risk adjustment, and technology • Coordinate cross-functional business, operational, and technology teams • Facilitate implementation working groups and governance meetings • Manage project risks, dependencies, issues, and escalations • Develop and execute regulatory readiness plans • Update policies, procedures, workflows, and job aids • Coordinate business process redesign and operational changes • Support training and communication initiatives • Coordinate technology enhancements, system configurations, and vendor updates • Oversee UAT, Business Validation Testing, Readiness Testing, and Production Validation • Support corrective action plans resulting from CMS audits and compliance reviews • Maintain implementation documentation and audit trails • Coordinate regulatory implementation with third-party vendors and delegated entities • Develop executive implementation status reports and dashboards • Present progress, risks, and readiness assessments to leadership • Provide go-live readiness and risk mitigation recommendations

🎯 Requirements

• Minimum (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 related field • Experience managing complex, cross-functional initiatives involving regulatory or compliance requirements • Strong understanding of project management principles and implementation methodologies • Exceptional stakeholder management and communication skills • Ability to interpret and operationalize regulatory requirements • Strong organizational and analytical skills • Ability to perform the essential physical functions described in the posting, with reasonable accommodations available