SR. DIRECTOR, REGULATORY COMPLIANCE
Company: HealthEdge
Location: Carson City
Posted on: September 26, 2024
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Job Description:
OverviewPosition Overview:Looking for a subject matter expert in
the healthcare regulatory & compliance space, with acumen and
passion for leveraging innovative technology to solve critical
needs in healthcare. This individual will report to the Chief
Medical Officer of Healthedge (HE) and ensure that our clinical
suite of products (GuidingCare & Wellframe) support our health plan
customers in achieving and maintaining compliance with the
regulatory bodies that govern them: NCQA (National Committee for
Quality Assurance), CMS (Centers for Medicare & Medicaid Services),
URAC (Utilization Review Accreditation Commission) and other State
regulatory bodies. The ideal candidate will have a strong
understanding of healthcare compliance requirements across multiple
regulatory bodies, as well as a deep knowledge of clinical software
programs, and the ability to discern the role of the vendor in
regulatory compliance.About Wellframe:With Wellframe, we reimagine
healthcare relationships through a new approach that uses high-tech
to deliver the high-touch support people need, when and where they
need it. We call it Digital Health Management. Our comprehensive
suite of Digital Health Management solutions for care management,
advocacy, and navigation help organizations forge more meaningful
connections with members, across their healthcare journey.
Wellframe was founded to counter a pressing industry problem: the
healthcare system has struggled to find ways to support people in
between care settings, at scale. We believe health plans are in the
best position to advocate for their members as they navigate their
health and care, but know that technology alone can't help us
achieve this ambition. That's why our team of physicians,
clinicians, public health experts, data scientists, engineers, and
healthcare industry experts ensure our patented technology works in
service of the person-to-person connections that make healthcare
work best. The complete suite of solutions from HealthEdge delivers
a digital foundation for payers specifically designed to fuel a
digital transformation, reduce costs, and improve both clinical
outcomes and the member experience.Your Impact:Proactively monitor
and interpret NCQA, URAC, CMS and key state regulations in
accordance with anticipated updates or revisions, providing expert
impacts relevant to our customers and our software.Partner with
enterprise legal & compliance team to identify and document
clinical regulations relevant to our HealthEdge productsCollaborate
with Product & Marketing stakeholders to establish clinical product
positioning as it pertains to regulatory compliance (i.e. what
is/should be a care management system & member engagement
application's role in the context of regulatory requirements - how
health plan customers should perceive our digital products & how
they advance their alignment/compliance with regulatory
requirements)Identify any areas of non-compliance in the
applications, services, and processes & analyze potential risks to
develop action plans when gaps are identifiedDevelop a compliance
scorecard; monitor and improve the adherence of the product
portfolio to the compliance scorecard.Research and track trends and
developments in governmental regulations related to compliance to
ensure that HealthEdge invests in an effective roadmap to maintain
compliance for our customers.Act as the subject matter expert and
advisor on relevant legislation and regulations that apply to
compliance and how this will impact our products & our
customers.Ensure that compliance requirements are correctly and
effectively communicated to all stakeholders; create periodic
regulation update briefs for internal use.Communicate changes in
regulations to customers in a clear and concise manner via multiple
methods: Conduct User Groups; 1:1 Sessions with key customers;
Delivering Blogs; Respond to questions via email from internal and
external customers.Ensure workflows, policies, and procedures are
implemented and maintained for relevant regulatory and
accreditation requirementsDevelop business cases and requirements
for new products and enhancements that advance organizational
alignment with regulatory requirements and credibility in the
marketDevelops and leads regulatory survey readiness planning
process for relevant accreditations and certificationsWhat You
Bring:Bachelor's degree in a healthcare related fieldLegal and/or
Clinical graduate-level or professional experience
preferredExperience in HEDIS data and analytics are
preferredExtensive experience in the healthcare industry,
particularly in the Payer space, with a perspective on how health
plan operations impact willingness to adopt digital transformation
and innovation7+ years' experience with healthcare
compliance/regulations - Medicare, Medicaid, federal and state
requirementsAdvanced knowledge and in-depth understanding of NCQA,
HEDIS, CMS, and State processing requirementsDemonstrated ability
to define & articulate business solutions to compliance issues; and
to educate and achieve alignment with internal and external
audiencesExperience working with regulatory requirements in a
software product development environmentFamiliarity with CMS
reporting, audit requirements and audit procedures.Demonstrated
attention to detailStrong interpersonal, communication,
organizational and coordination skillsThe ability to work
independently, as well as part of a team or as team leaderStrong
analytical and storytelling capabilitiesHealthEdge commits to
building an environment and culture that supports the diverse
representation of our teams. We aspire to have an inclusive
workplace. We aspire to be a place where all employees have the
opportunity to belong, make an impact and deliver excellent
software and services to our customers.Geographic Responsibility:
While HealthEdge is located in Burlington, MA you may live anywhere
in the USType of Employment: Full-time, permanentWork Environment:
The physical demands described here are representative of those
that must be met by an employee to successfully perform the
essential functions of this job:The employee is occasionally
required to move around the office. Specific vision abilities
required by this job include close vision, color vision, peripheral
vision, depth perception, and ability to adjust focus.Work across
multiple time zones in a hybrid or remote work environment.Long
periods of time sitting and/or standing in front of a computer
using video technology.May require travel dependent on company
needs.The above statements are intended to describe the general
nature and level of the job being performed by the individual(s)
assigned to this position. They are not intended to be an
exhaustive list of all duties, responsibilities, and skills
required. HealthEdge reserves the right to modify, add, or remove
duties and to assign other duties as necessary. In addition,
reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions of this position in
compliance with the Americans with Disabilities Act of 1990.
Candidates may be required to go through a pre-employment criminal
background check.HealthEdge is an equal opportunity employer. We
are committed to workforce diversity and actively encourage all
qualified persons to seek employment with us, including, but not
limited to, racial and ethnic minorities, women, veterans and
persons with disabilities.#LI-RemoteJob Locations US-RemoteID
2024-4723Category Hidden (29000)Position Type Full-TimeHealthEdge
provides equal employment opportunities to all employees and
applicants for employment and prohibits discrimination and
harassment of any type without regard to race, color, religion,
age, sex, national origin, disability status, genetics, protected
veteran status, sexual orientation, gender identity or expression,
or any other characteristic protected by federal, state or local
laws.
Keywords: HealthEdge, Carson City , SR. DIRECTOR, REGULATORY COMPLIANCE, Executive , Carson City, Nevada
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