Job Title: Administrator, Regulatory Compliance
Job ID: 728641
Shift: Day Job
Facility: UPMC Health Plan
Department: Compliance & Ethics
Location: 600 Grant St, Pittsburgh PA 15219
UPMC Health Plan is seeking an Administrator- Regulatory Compliance!
Under the direction of the Senior Director of the Corporate Compliance & Ethics Office, the Administrator, Regulatory Compliance monitors and researches compliance of UPMC Insurance Services Division with existing federal and state regulations and statutes for managed care and worker's compensation organizations. Incumbent functions as liaison with appropriate state agencies, oversees all regulatory filings, reporting, licensing and coordinates service area expansions.
Law background preferred
Previous experience researching and analyzing managed care and worker's compensation laws and regulations preferred
Previous experience drafting/modifying policies and procedures to meet regulatory standards preferred
Previous experience translating regulatory or technical standards into simple, clear written instructions preferred
Coordinates obtaining licenses to offer health plans and worker's compensation in new states (e.g., HMO, PPO, third party administration, utilization review)
Researches state laws and regulations related to licensure
Assist business units to incorporate expansion state regulatory requirements into operating policies and procedures
Oversee preparation of quarterly and annual regulatory reports required by license
Reviews drafts and/or drafts (as requested) policies and procedures from a regulatory/compliance perspective
Updates key management of regulatory changes/developments and implications of new health care, worker's compensation legislative initiatives to the functional areas of UPMC Insurance Services Division.
Works with Senior Director of Compliance and designated departments to coordinate compliance monitoring
Bachelors degree required.
Masters degree and/or paralegal certificate preferred.
Previous management/supervisory experience preferred.
Five years health insurance, government products, or regulatory review required.
Must have strong analytical 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, state, or accreditation standards.
Excellent oral and written communication and computer skills.
Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities
Salary Range: $30.89 to $52.76
Union Position: No
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University Of Pittsburgh Medical Center