Regulatory Guidance Manager
Company: MetroPlusHealth
Location: New York City
Posted on: July 13, 2025
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Job Description:
Job Description Job Description Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting
communities through care. We believe that Health care is a right,
not a privilege. If you have compassion and a collaborative spirit,
work with us. You can come to work being proud of what you do every
day. About NYC Health Hospitals MetroPlusHealth provides the
highest quality healthcare services to residents of Bronx,
Brooklyn, Manhattan, Queens and Staten Island through a
comprehensive list of products, including, but not limited to, New
York State Medicaid Managed Care, Medicare, Child Health Plus,
Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
As a wholly-owned subsidiary of NYC Health Hospitals, the largest
public health system in the United States, MetroPlusHealth network
includes over 27,000 primary care providers, specialists and
participating clinics. For more than 30 years, MetroPlus has been
committed to building strong relationships with its members and
providers to enable New Yorkers to live their healthiest life.
Position Overview Empower. Unite. Care. MetroPlusHealth is
committed to empowering New Yorkers by uniting communities through
care. We believe that Health care is a right, not a privilege. If
you have compassion and a collaborative spirit, work with us. You
can come to work being proud of what you do every day. The
Regulatory Guidance Manager is responsible for ensuring regulatory
compliance by disseminating guidance to affected business units.
The position will develop and maintain relationships with
regulatory agencies and stay up to date on any changes or updates
to regulations. The position is accountable for supporting the
Director of State Regulatory Guidance and will provide guidance to
staff as well as conduct regulatory research and analysis to
identify and interpret regulatory requirements and trends. Job
Description - Ensure timely dissemination of accurate guidance for
applicable laws and regulations related to all NYS regulated Lines
of Business (LOBs) that the Plan offers. - Develop and coordinate
with the Project Management Team (PMO) and the Product Team on
workplans to implement new regulatory changes. - Provide guidance
and conduct regulatory research and analysis to help identify and
interpret requirements and trends. - Evaluate the impact of
regulatory changes on the organization and advise plan leadership
on necessary actions. - Develop and maintain relationships with
regulatory agencies and stay up-to-date on any changes or updates
to regulations. - Participate in stakeholder calls and create
summaries of calls for dissemination to senior staff. - Work with
the Compliance Operations team to manage the preparation and
submission of regulatory filings, reports, and documentation. -
Identify and assess potential regulatory risks and develop
strategies to mitigate those risks. - Collaborate with
cross-functional teams to ensure compliance across all areas of the
organization. - Participate in high-level implementations of
carve-in/carve-out services; program services such as changing
vendors or adding new vendors. - Participate in various external
audits/surveys such as the Article-44 Operational Survey to ensure
compliance with state regulations. Upload all requested information
into the Health Commerce System (HCS), the state’s database, as
necessary. - Other duties as assigned by the Director, Senior
Director, or Chief Compliance & Regulatory Officer. Minimum
Qualifications - Bachelor's degree required; and - 5 years of
Regulatory Affairs work experience; or - A satisfactory equivalent
combination of education, training, and experience in other Managed
Care operational departments. - Master’s degree or Juris Doctorate
preferred. - Experience with NY State managed care products
strongly preferred. - Strong knowledge of healthcare laws and
regulations, including HIPPA, Medicare and Medicaid. - Proficient
MS Word, Excel, SharePoint and PowerPoint required. Professional
CompetenciesIntegrity and Trust - Customer Focus -
Functional/Technical skills - Excellent analytical,
problem-solving, and decision-making skills - Excellent
communications and interpersonal skills, with the ability to
effectively communicate complex regulatory requirements to
departmental staff at all levels - Ability to prioritize and manage
multiple tasks in a fast-paced environment - Strong attention to
detail and accuracy - Ability to meet deadlines, multi-task,
problem solve and use appropriate technology to analyze business
problems - Project management skills a plus LI-REMOTE MPH-50
Keywords: MetroPlusHealth, Hicksville , Regulatory Guidance Manager, Healthcare , New York City, New York
