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Job Title

Regulatory Affairs Program Manager

Department

Legal Affairs

Exemption Status

Exempt

Requisition #

24946

Direct Reports

N/A

Manager Title

Director, Regulatory Affairs

Pay & Benefits

Estimated hiring range $ 88,430 $ 108,080 /year, 5% bonus target, full benefits.

www.careoregon.org/about-us/careers/benefits

Posting Notes

This role will require you to travel into the downtown Portland office once a quarter.

Job Summary

The Regulatory Affairs Program Manager is focused on regulatory compliance, contractual deliverables, and internal communications across the organization to ensure that regulatory and contractual obligations are met effectively and efficiently. This position will provide leadership and expertise for regulatory, programmatic and project related matters, collaborating closely with the Director and Regulatory Affairs Portfolio Manager to ensure smooth processes.

Essential Responsibilities

Contractual Deliverables Program Administration

+ Develop, implement, and sustain the enterprise state deliverables program of a health plan with multiple lines of business and matrixed operations.

+ Develop, implement, and sustain policies, procedures and workflows that will be utilized by matrixed operations and would be utilized to demonstrate processes to federal/state regulators.

+ Manage the configuration of an automated database, customized dashboards, requirements tracking, and the maintenance of associated regulatory communications, for the life cycle of deliverables, from initial submission to approval.

+ Manage deliverables-related to strategic communications with the OHA and HSO in collaboration with government affairs personnel.

+ Build and maintain strategic alliances with other CCOs and attend deliverable and operational collaborative forums (e.g., CCO Oregon).

+ Develops, Implements, and sustains regular reporting that will be utilized to inform and update the CCO CEOs.

+ Facilitates coordination of large, complex, or at-risk deliverables, especially those that require input from multiple internal stakeholders.

+ Initiate outreach to business units to ensure quality deliverables including coaching on how to achieve higher quality submissions.

+ Develop, implement, and sustain a quality/performance review of deliverables prior to submission to regulators or contractors.

+ Use data analytics to identify and monitor trends in regulatory submissions and pursue initiatives that offer efficiencies, close gaps, and reduce barriers to operational reporting requirements.

+ Identify moderate to high-risk items to escalate to the legal or compliance teams such as potential compliance issues, requests for extension or rule/interpretation questions.

+ Maintaining support site for staff, including resource materials.

Information/regulatory Communication Program Administration

+ Develop, implement, and sustain an Information/regulatory Communication Program.

+ Develop, implement, and sustain policies, procedures and workflows that will be utilized by matrixed operations and would be utilized to demonstrate processes to federal/state regulators.

+ Manage the configuration of an automated database, customized dashboards, requirements tracking, and the maintenance of associated informational/regulatory communications.

+ Develops, Implements, and sustains regular reporting that will be utilized to inform and update the CCO CEOs.

+ Identify moderate to high-risk items to escalate to the legal or compliance teams such as requests for extension or rule/interpretation questions.

+ Maintaining support site for staff, including resource materials.

Project Leadership

+ Provide program and project leadership for assigned area to the regulatory affairs department.

+ Collaborate with internal departments and leadership to determine appropriate changes to existing program.

+ Create programmatic materials that educate the organization and internal teams regarding changes to the deliverables program and the Informational/regulatory communication program.

Department Policies and Operations

+ Play a critical role in developing and maintaining infrastructure and procedures based on management direction.

+ Orient CareOregon staff to deliverables process; function as an advanced resource to staff on contractual deliverables and contractual performance related matters.

+ Orient CareOregon staff to informational/regulatory communication process; function as an advanced resource to staff on informational/regulatory communication related matters.

Organizational Responsibilities

+ Perform work in alignment with the organization’s mission, vision and values.

+ Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.

+ Strive to meet annual business goals in support of the organization’s strategic goals.

+ Adhere to the organization’s policies, procedures and other relevant compliance needs.

+ Perform other duties as needed.

Experience and/or Education

Required

+ Minimum 5 years’ interaction and communication with federal and/or state regulatory agencies

+ Minimum 3 years’ progressive experience with Medicare and/or Managed Care

+ Minimum 2 years’ facilitating or overseeing implementation of contract requirements

Preferred

+ Bachelor's degree in business, Health Care Administration, Analytics, or related degree

Knowledge, Skills and Abilities Required

Knowledge

+ Extensive knowledge of managed care and the Oregon Health Plan

+ Strong knowledge of federal Medicare regulations and state Medicaid rules (OARs)

+ Knowledge of OHA contractual deliverables portal and processes

Skills and Abilities

+ Excellent analytical skills

+ Excellent written and verbal communication skills

+ Strong word processing, spreadsheet, and database skills

+ Ability to develop and maintain effective relationships with internal and external partners

+ Ability to achieve desired outcomes through effective relationship skills

+ Ability to negotiate and implement complex reimbursement arrangements

+ Ability to maintain professional relationships with internal staff and departments

+ Ability to independently work with providers, provider groups and other populations in addressing and resolving problems

+ Ability to work independently, organize, prioritize, and manage multiple projects

+ Ability to work effectively with diverse individuals and groups

+ Ability to learn, focus, understand, and evaluate information and determine appropriate actions

+ Ability to accept direction and feedback, as well as tolerate and manage stress

+ Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day

+ Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure

Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Hybrid-Office 1-2 days/month

#LI-Hybrid

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.