RiverSpring Living
MLTC-Regulatory Affairs Associate
RiverSpring Living - New York, New York, us, 10261
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Overview
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MLTC-Regulatory Affairs Associate
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RiverSpring Living 5 days ago Be among the first 25 applicants Join to apply for the
MLTC-Regulatory Affairs Associate
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RiverSpring Living Immediate Full Time Opportunity Available – Bronx, NY
RiverSpring Health Plans serves over 18,000 frail individuals, helping them live independently in their homes for as long as possible. Join our compassionate and dedicated team to make a difference in the lives of our members!
We are currently seeking a
Regulatory Affairs Associate
to be responsible for the planning, development, direction, delivery, evaluation, and coordination of activities within our Regulatory Affairs Department. This key position will focus on regulatory compliance, contracts, provider relations, audits, investigations, and other related matters.
Key Responsibilities
Contracts and Agreements: Review, draft, negotiate, and process agreements and amendments per organizational guidelines. Audit and Survey Management: Manage projects involving the collection and submission of data and information related to government audits, surveys, and requests. Provider Relations and Contracting: Handle provider contracting, including letters of agreement, and conduct follow-up. Fair Hearing (FH) Management: Review, disseminate, and handle FH notices; manage the FH calendar; conduct preparations for FHs and attend as needed. Review and handle communications and submit reports. Prepare status reports and updates on cases. Special Investigations: Handle activities of the Special Investigation Unit (SIU), including reporting and internal investigations. HIPAA Compliance: Update applicable HIPAA policies and procedures in compliance with laws and regulations. OIG/OMIG Compliance: Review OIG/OMIG requirements and best practices; update compliance materials, policies, and procedures to ensure adherence to regulations. DOH and CMS Contracts: Review and edit DOH and CMS plan contracts to ensure compliance with contract requirements. Regulatory Guidance: Review and disseminate CMS memos and DOH guidance, keeping up to date on laws and official guidance. Litigation and Legal Requests: Coordinate document requests from outside counsel for litigation matters. Database Management: Maintain databases related to provider credentials and other essential information. Policy Development: Draft policies, procedures, manuals, and plan materials. Team Oversight: Provide oversight and supervision of department staff.
Qualifications
Juris Doctorate Required Minimum 3 years of experience in managed care contracting, credentialing, and compliance. Strong knowledge of MLTC, MAP, Medicaid, and Medicare programs. Commensurate supervisory experience. Ability to review and analyze legal and commercial terms of agreements. Proficient in investigating incidents and recommending solutions. Highly skilled in organizational management, attention to detail, and multitasking. Excellent writing, editing, and proofreading skills.
Compensation
$150,000 - $165,000 annually Benefits include health insurance, retirement plans, paid time off, and professional development opportunities.
Equal Opportunity Employer (EOE)
If you are dedicated to making a meaningful impact in the lives of others and have the qualifications for this role, we invite you to apply! Seniority level
Seniority level Associate Employment type
Employment type Full-time Job function
Job function Legal Industries Non-profit Organizations, Hospitality, and Hospitals and Health Care Referrals increase your chances of interviewing at RiverSpring Living by 2x Get notified about new Regulatory Affairs Associate jobs in
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MLTC-Regulatory Affairs Associate
role at
RiverSpring Living 5 days ago Be among the first 25 applicants Join to apply for the
MLTC-Regulatory Affairs Associate
role at
RiverSpring Living Immediate Full Time Opportunity Available – Bronx, NY
RiverSpring Health Plans serves over 18,000 frail individuals, helping them live independently in their homes for as long as possible. Join our compassionate and dedicated team to make a difference in the lives of our members!
We are currently seeking a
Regulatory Affairs Associate
to be responsible for the planning, development, direction, delivery, evaluation, and coordination of activities within our Regulatory Affairs Department. This key position will focus on regulatory compliance, contracts, provider relations, audits, investigations, and other related matters.
Key Responsibilities
Contracts and Agreements: Review, draft, negotiate, and process agreements and amendments per organizational guidelines. Audit and Survey Management: Manage projects involving the collection and submission of data and information related to government audits, surveys, and requests. Provider Relations and Contracting: Handle provider contracting, including letters of agreement, and conduct follow-up. Fair Hearing (FH) Management: Review, disseminate, and handle FH notices; manage the FH calendar; conduct preparations for FHs and attend as needed. Review and handle communications and submit reports. Prepare status reports and updates on cases. Special Investigations: Handle activities of the Special Investigation Unit (SIU), including reporting and internal investigations. HIPAA Compliance: Update applicable HIPAA policies and procedures in compliance with laws and regulations. OIG/OMIG Compliance: Review OIG/OMIG requirements and best practices; update compliance materials, policies, and procedures to ensure adherence to regulations. DOH and CMS Contracts: Review and edit DOH and CMS plan contracts to ensure compliance with contract requirements. Regulatory Guidance: Review and disseminate CMS memos and DOH guidance, keeping up to date on laws and official guidance. Litigation and Legal Requests: Coordinate document requests from outside counsel for litigation matters. Database Management: Maintain databases related to provider credentials and other essential information. Policy Development: Draft policies, procedures, manuals, and plan materials. Team Oversight: Provide oversight and supervision of department staff.
Qualifications
Juris Doctorate Required Minimum 3 years of experience in managed care contracting, credentialing, and compliance. Strong knowledge of MLTC, MAP, Medicaid, and Medicare programs. Commensurate supervisory experience. Ability to review and analyze legal and commercial terms of agreements. Proficient in investigating incidents and recommending solutions. Highly skilled in organizational management, attention to detail, and multitasking. Excellent writing, editing, and proofreading skills.
Compensation
$150,000 - $165,000 annually Benefits include health insurance, retirement plans, paid time off, and professional development opportunities.
Equal Opportunity Employer (EOE)
If you are dedicated to making a meaningful impact in the lives of others and have the qualifications for this role, we invite you to apply! Seniority level
Seniority level Associate Employment type
Employment type Full-time Job function
Job function Legal Industries Non-profit Organizations, Hospitality, and Hospitals and Health Care Referrals increase your chances of interviewing at RiverSpring Living by 2x Get notified about new Regulatory Affairs Associate jobs in
New York, NY . Regulatory Affairs Associate - Quality/Regulatory
Totowa, NJ $55,500.00-$59,000.00 1 month ago Norwood, NJ $70,000.00-$75,000.00 4 days ago Medical Devices Regulatory Affairs Strategy Specialist
New York, NY $116,000.00-$168,000.00 1 week ago Office of Regulatory Relations, Bank Regulatory Engagement, Associate, New York
Quality and Regulatory Affairs Specialist-Mount Sinai Brooklyn - Full-time
Brooklyn, NY $87,692.00-$131,538.00 2 weeks ago Associate - Regulatory Compliance (Private Funds)
Office of Regulatory Relations, Non-Prudential Regulatory Team, Associate, New York
Specialist, NOAM Scent Regulatory Affairs (Hybrid)
New York, NY $72,800.00-$91,000.00 3 days ago Clerical Associate - Administrative Law & Regulatory Litigation
Bronx, NY $160,000.00-$180,000.00 4 days ago Regulatory Affairs Manager - Medical Device
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New York, NY $89,000.00-$118,000.00 4 days ago Regulatory Identification and Change Management Officer
New York, NY $110,000.00-$125,000.00 2 months ago New York, NY $53,200.00-$77,280.00 2 weeks ago Jersey City, NJ $125,000.00-$135,000.00 1 week ago Internal Audit-New York-Associate- Regulatory Relations Team
Quality and Regulatory Affairs Specialist-Mount Sinai Brooklyn - Full-time
Brooklyn, NY $87,692.00-$131,538.00 2 weeks ago We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr