Incumbent leads the State Regulatory Affairs department and responsible for developing and executing the Medicaid Regulatory Affairs strategy, focused on publicly funded healthcare programs. Provides guidance, oversight and support to Regulatory Affairs teams with respect to contract administration and account management. Provides strategic guidance from a regulatory perspective to the market leader, COO and/or leadership team. Partners with state Medicaid agency to ensure compliance and effective partnership.
Identifies, compiles and aggregates regulatory and operational issues across markets to manage risk. Partners with markets on resolutions through expertise and lessons learned.
Makes timely and effective decisions using data and takes a fact-based approach to problem-solving, while understanding the limits of data to make and support decisions.
Establishes the Medicaid Regulatory Affairs strategy and oversees contract administration activities in markets.
Manages and supports audits and implementations to ensure regulatory requirements are satisfied.
In partnership with Corporate Compliance, develops procedures, toolkits and reports and monitors contractually required deliverables, including but not limited to, regulatory reports and performance metrics.
Develops procedures and toolkits for Account Management Plans and monitors adherence with corporate processes.
Directs and manages a team of associates responsible for supporting Medicaid Regulatory Affairs initiatives and teams.
Supports development and implementation of Regulatory Affairs in new markets.
Develops and manages department budget.
Performs special projects as needed.
Required A Bachelor's Degree in business administration or related field
Preferred A Master's Degree in public policy, public health, political science, health administration or related field
Required 10 years of experience in managed health care or health care consulting
Required 5 years of management experience
Intermediate Demonstrated leadership skills
Intermediate Ability to lead/manage others
Intermediate Other facilitative skills
Intermediate Other In-depth knowledge of government programs and the managed care industry and experience leading and managing regulatory affairs programs through teamwork, collaboration and open communication
Required Intermediate Microsoft Project Strong knowledge of MS Office including Project, Access, PowerPoint and Visio
Required Intermediate Microsoft Access Knowledge of and/or ability to utilize COGNOS for budgetary decisions or review
Required Intermediate Microsoft PowerPoint
Required Intermediate Microsoft Visio
Required Intermediate Other Knowledge of and/or ability to utilize COGNOS for budgetary decisions or review
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.