UPMC Jobs

UPMC Health Plan's Commercial Compliance team is looking for a Senior Administrator, Regulatory Compliance to join the team!

Under the direction of the Director of Compliance, the Senior Administrator, Regulatory Compliance, monitors compliance of UPMC Insurance Services Division with existing federal and state regulations and statutes for managed care organizations. Incumbent functions as liaison with appropriate state agencies, oversees regulatory filings, compliance requirements and coordination of service area expansions and licensure. This position has oversight for the commercial compliance program.

This is a fully remote position but does require traveling to the corporate offices in Pittsburgh, PA.

Responsibilities:

• Participates in workgroups

• Oversees preparation of quarterly and annual reports to PA DOH/PID and comparable reporting requirements for other applicable states UPMC Insurance Services Division conducts business.

• Assists the Senior Director of Compliance regarding Compliance implementation including training.

• Oversight for licensure applications and renewals.

• Must have strong analytical, regulatory research, and organizational skills as well as problem solving capabilities to verify that business plans and/or strategies do not place the company in violation of federal or state regulations.

• Works with UPMC-HP staff on review of proposed health care legislation and implementation schedules for newly enacted health care legislation and regulations.

• Develops and maintains the review process.

• Enhances existing Compliance communication strategies for the organization

• Establishes and implement criteria for regulatory interpretation turnaround with regulatory team Assist in development and mentorship of other Regulatory Administrators

• Reports on a weekly basis status of all assignments pertinent information obtained during report week and provides projections for upcoming week to Senior Director of Compliance.

• Reviews drafts and/or drafts (as requested) UPMC-HP policies and procedures from a compliance perspective-and maintains required corporate policies and procedures.

• Performs gap analysis, risk assessment as needed for compliance purposes

• Updates key UPMC-HP management staff of regulatory changes/ developments, and implications of new managed care legislative initiatives on functional areas of UPMC Insurance Services Division.

• Works with Senior Director of Compliance, to coordinate regulatory monitoring visits

• As requested by key UPMC-HP management staff, works on responses to RFPs and grant programs for other government programs

• Bachelor's degree required. Master's degree preferred.

• Previous administrative experience in a medical insurance setting and at least six years of regulatory (DOH or PID) experience required.

• Must have strong analytical and organizational skills, as well as problem-solving capabilities to ensure that business plans and/or strategies do not place the company in violation of any federal, state, or accreditation standards.

• Supervisory experience preferred.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran