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Job Details

Behavioral Health Regulatory Affairs Analyst

Job Ref: 67844
Category: Professional
Department: OFFICE CORPORATE COMPLIANCE
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $96,000.00
Salary Range: $96,000.00 - $111,675.00

About NYC Health + Hospitals

MetroPlus Health Plan 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, MetroPlus’ 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
The Behavioral Health (BH) Regulatory Affairs Analyst reports to the Senior Director of Regulatory Affairs. The Analyst will support the organization in meeting all state and federal regulatory requirements for all our lines of business including Medicaid and Health and Recovery Plan (HARP), Children’s Special Services and Foster Care
regulatory activities, including the dissemination of regulatory guidelines and updates. This dissemination will encompass all impacted departments. The Analyst will work with State government agencies (State Department of Health (SDOH), Office of Mental Health (OMH), Office of Substance Use Services (OASAS), Office of Children &
Family Services (OCFS), Department of Financial Services (DFS) and the Centers of Medicare Services (CMS) and US Department of Health & Human Services (HHS) to ensure that all regulatory requirements are met. The Analyst will also help support implementation of regulatory guidance, assist with corrective action plans and implementation plans.

Job Description

• Disseminate all regulatory guidelines and administrative memos related to behavioral health services related to Adult and Children services.
• Compile and maintain regulatory documentation in our documentation database (Quickbase) and Submissions Tracker in order to meet all regulatory timeframes.
• Serve as a Government Liaison and participate in various committees and workgroups to obtain information necessary to provide guidance to the Behavioral Health Department and the organization.
• Coordinate efforts associated with the preparation of regulatory documents or submissions to the State or Federal agencies or other stakeholders such as the PHP Association and/or Health Plan Association (HPA).
• Communicate with regulatory agencies regarding questions, clarification requests and submissions.
• Interpret regulatory rules and guidance and ensure that this is communicated to our BH Department so that they can implement specific guidance and/or develop appropriate policies and procedures that incorporates the guidance.
• Review complaint trends and make recommendations regarding their reportability.
• Assist in the coordination and participation of State on-site or virtual surveys related to our behavioral health services such as OMH specific surveys and Article-44 surveys. Will work with all departments to ensure that all materials requested by the State are submitted. Assist in prepping staff for surveys including conducting mock surveys and review of materials.
• Prepare reports and information for the Internal Compliance Committee Meetings and Adult & Compliance Committee meetings. quality and timely data for the materials prepared for the Internal Compliance Committee Meetings and Audit, Compliance, and Behavioral Health Utilization Management and Quality Management Subcommittees.
• Review product materials and website specific to behavioral health to ensure compliance with regulatory regulations and policies. Work closely with the Communications Department to review materials and to make recommendations when changes are required and submit materials (when requested) to the State for review and approval.
• Upon identification of non-compliance, provide support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and Compliance review. Plays a critical role in driving the progress for corrective actions throughout the organization.
• Coordinates the support for business areas in creating and updating monitoring metrics to assess continued compliance with regulatory requirements.
• Other duties as assigned or requested.

Minimum Qualifications

• A Bachelor’s degree required.
• 3-5 years’ experience with Medicaid and behavioral health substance abuse case/care management and/or operations.
• 3-5 years’ experience in a compliance, regulatory affairs, or government affairs function within a Managed Care Organization.
• Prior successful experience working in the concentrated area of behavioral health is a plus.
• Experience managing complicated projects, keeping track of details, and staging work to deliver projects on time.
• Proven ability to articulate regulatory requirements to business and technical staff to capture information and achieve results.
• Experience with developing reporting.

Professional Competencies
• Solid Microsoft Excel skills and strong proficiency using MS Word and PowerPoint.
• High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
• Simultaneously manage multiple projects.
• Excellent oral, written, analytical and presentation skills required.
• Ability to interpret regulatory guidance and summarize guidance.
• Ability to multi-task various projects at the same time.
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary.