Regulatory Policy Consultant; Remote

Overview

PURPOSE: Provides strategic and tactical planning, as well as, knowledge services relating to the implementation of key mandate initiatives, covering a broad range of legislative and regulatory matters including:
Federal, BCBSA, Government Programs, State. Provides internal and external liaison functions, workflow, customer service, communications, training, strategic delivery, efficiency, cost reduction and skill development initiatives. We are looking for an experienced professional to work remotely. The incumbent will be expected to come into a Care First location periodically for meetings, training and/or other business-related activities.

• Analyzes legislation and regulations as it relates to Care First and creates high level compliance requirements.
• Primary/dedicated Regulatory point of contact for Project Managers who implementation projects.
• Takes a lead role in various department and divisional projects, to ensure compliance with project compliance requirements, providing input on work team participants, identification of business needs and development of solutions, training, collaboration and communication.
• Present content, insights and guidance to Mandates and other Care First business areas, BCBSA and/or Blues Plans as needed for generating successful knowledge sharing and working relationships.
• Collaborate with other Care First Divisions/Departments and functional areas to help with identification of workflow opportunities driven by projects, operational changes and/or external regulations.
• Represent Mandates on Corporate and external facing work groups, legislative, regulatory, and stakeholder bodies work groups, Americas Health Insurance Plans (AHIP), the Blue Cross and Blue Shield Association (BCBSA), as needed.
• Identify opportunities to create more robust processes surrounding new mandate projects to improve the throughput of the department, streamline operations, improve project outcomes and increase strategic alignment of technical delivery with business operations.
• Leverage strong business acumen to act as a subject matter expert on a variety of Mandate and cross departmental projects, adding strategic perspective to project and problem-solving efforts.
• Support internal and external policy decisions by providing management with analysis and recommendations on the operational impacts to Care First from external mandates.
• Support the efforts of the Mandates and ePMO team in the creation, quality assurance and refinement of Project Documentation and Status Reporting.

Position does not have direct reports but is expected to assist in guiding and mentoring less experienced staff. May lead a team of matrixed resources.

Education Level: Bachelor s Degree in Business, Finance or Technology fields.

Experience: 10 years  Healthcare operations and/or healthcare regulatory business background. Project management of healthcare related projects may be substituted for some of the years of business experience.

• Advance degree or Certificate in Public Health, Public Policy, Business, Finance or IT fields; or 15+ years progressive healthcare operations and/or healthcare regulatory experience.
• Experience and exposure to both IT and Business functions in a management position.
• Strong experience in connecting strategic imperatives to tactical project delivery, in collaboration with senior business and IT executives.

• Considerable judgment, tact, initiative, accuracy and integrity. Excellent interpersonal skills with ability to build consensus and agreement and bring resolution to contentious issues and entrenched interests.
• Superior analytical skills and understanding of where to find information germane to mandates.
• Ability to research complex issues, interpret regulations and regulatory rules/guidance, and exhibit sound judgment in determining a recommendation or solution to a problem.
• Skill in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
• Self-motivated with a commitment to teamwork.
• Ability to recognize, analyze, and solve a variety of problems.
• Ability to convey information in a clear, concise, and logical manner.
• In-depth understanding of healthcare payor industry and operational processes and impacts of regulatory guidance.
• Effective written and interpersonal communication skills.
• Knowledge of state legislative and regulatory processes, public policy analysis.
• In-depth understanding of healthcare payor industry and operational processes and impacts of regulatory guidance.
• Understanding of insurance products and regulatory environment.
• Proven analytical and problem-solving skills to evaluate business processes and recommend effective solutions.
• Experience in project management, business process analysis, workflow, and task analysis.
• Analytical skills and understanding of where to find information germane to mandates.
• Must be…