Director, Regulatory Affairs

Job Title

Director, Regulatory Affairs

Department

Legal Affairs

Exemption Status

Exempt

Requisition #

24369

Direct Reports

Regulatory Affairs Manager

Manager Title

VP, General Counsel, Legal & Regulatory Affairs

Pay & Benefits

Estimated hiring range $ 136,530 - $166,870, / year, 10% bonus target, full benefits.

careoregon. org/about-us/careers/benefits

Posting Notes

This is a Hybrid role ( 4 days a month in office or community)

Job Summary

This position is responsible for overseeing and ensuring the quality of contractual and regulatory obligations to the Oregon Health Authority (OHA) and related federal agencies on behalf of CareOregons affiliated CCOs across all government products. Primary duties include strategic planning, operational planning and oversight, as well as resource, relationship, and people management. This position works with the enterprise to present a unified and organized voice to the OHA and other external stakeholders, leads the successful resolution of regulatory or statutory barriers, and provides guidance internally on new federal or state requirements. This position also oversees the administration of CareOregons centralized policy management program and PolicyTech application.

Essential Responsibilities

Technical/Operational Leadership

+ Provides leadership and direction on operational issues with associated OAR or contractual requirements as applied to the CareOregon portfolio of business.

+ Maintains awareness of significant regulatory changes at the state and federal level and is able to estimate the operational and resource impacts to the CareOregon enterprise.

+ Effectively organizes internal teams with defined goals and objectives in response to regulatory challenges.

+ Oversees the creation of tools, processes, and other supports to inform and organize all internal statkeholders to achieve regulatory objectives.

+ Creates and maintains external relationships with key stakeholders at other CCOs, OHA, and community partners.

+ Develops strategic communications in collaboration with leadership, government affairs and legal staff.

+ Regularly informs or presents to the CCO CEOs, various Boards of Directors, and OHA Workgroup of key regulatory issues.

+ Maintains knowledge of Medicaid managed health care challenges, trends, and emerging issues nationally.

+ Works with Public Policy staff and internal CareOregon staff to analyze, draft, and submit written comments during state and federal administrative rulemaking on proposed rules that impact CareOregon, the Oregon Health Plan, CareOregons provider network, or CareOregon members.

+ Creates and maintains department specific policies.

+ Oversees the CareOregon enterprise policy management function and PolicyTech vendor (NAVEX).

+ Collaborates with Compliance, Legal Affairs, and Government Affairs on complex issues.

Strategic/Operational Planning

+ Participates in the development of vision, goals, and strategic plans for the department.

+ Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.

+ Provides input into the strategic plans for the organization.

+ Maintains a business unit view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Financial/Resource Management

+ Recommends budgets in alignment with short- and long-term plans.

+ Manages resources to ensure priorities are accomplished.

+ Approves resource allocations within budget, including people, finances, and timelines; make decisions on exceptions.

Relationship Management

+ Leads effective communication system for work group, ensuring a collaborative culture.

+ Builds and ensures effective relationships across internal teams and external organizations for current or future integration.

+ Partners with internal leaders and managers in identifying improvement plans and processes.

+ Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.

Employee Supervision

+ Directs team(s) and establishes team direction and goals in alignment with the organizational mission, vision, and values.

+ Identifies work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens.

+ Identifies department priorities; ensures employees have information and resources to meet job expectations.

+ Leads the development, communication, and oversight of team and individual goals; ensures goals, expectations, and standards are clearly understood by staff.

+ Manages, coaches, motivates, and guides employees; promotes employee development.

+ Incorporates guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, budgeting, resource allocation, and decision making.

+ Ensures team adheres to department and organizational standards, policies, and procedures

+ Evaluates employee performance and provides regular feedback to support success; recognizes strong performance and addresses performance gaps and accountability (corrective action).

+ Performs supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

+ Perform work in alignment with the organizations mission, vision and values.

+ Support the organizations commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.

+ Strive to meet annual business goals in support of the organizations strategic goals.

+ Adhere to the organizations policies, procedures and other relevant compliance needs.

+ Perform other duties as needed.

Experience and/or Education

Required

+ Minimum 10 years experience with the Medicaid operations, compliance, and/or regulatory affairs

Preferred

+ Minimum 4 years experience in a supervisory position

+ Experience working with coordinated care organizations in Oregon

Knowledge, Skills and Abilities Required

Knowledge

+ Knowledge of managed health care operations

+ Knowledge of Medicaid regulatory structure: CFR, ORS, OAR

+ Ability to organize internal initiatives and responses for an external audience

Skills and Abilities

+ Excellent negotiation and consensus building skills

+ Ability to identify, evaluate and develop strategies to eliminate health disparities for OHP members

+ Ability to build and maintain professional relationships with business, community and legislative groups

+ Proficiency with SmartSheets and SharePoint

+ Competency with computer software programs, e. g. , MS .