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UPMC Health Plan is looking for a Regulatory Compliance Admin to join the Commercial Compliance team!

Under the direction of the Corporate Compliance 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 organizations. Incumbent functions as liaison with appropriate state agencies, oversees all regulatory filings, reporting and coordinates service area expansions.

Responsibilities:

• Leads project teams for compliance.
• Updates key management staff of regulatory changes/developments and implications of new health care legislative initiatives on functional areas of UPMC Insurance Services Division.
• Reports on a weekly basis status of all assignments pertinent information obtained during report week. Provides projections for upcoming week.
• Works with Senior Director of Compliance and designated departments to coordinate compliance monitoring
• Oversees preparation of quarterly and annual reports to PA DOH/PID and comparable reporting requirements for Ohio and West Virginia, lobby expense reporting and licensure renewals. Leads team for state/county expansions
• As requested by key UPMC-HP management staff, works on responses to RFPs and grant programs for government programs
• Provides direct supervision of staff.
• Reviews drafts and/or drafts (as requested) policies and procedures from compliance perspective and maintains required Corporate policies and procedures
• Works with UPMC-HP staff on review of proposed health care legislation and implementation schedules for newly enacted health care legislation and regulations
• Assists the Corporate Compliance Office with the Compliance Committee, Policy & Procedure Committee, Policy & Procedure Subcommittee and Compliance training.
• Bachelor's degree required. Masters degree and/or paralegal certificate preferred.
• Previous management/supervisory experience preferred.
• 5 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/Disability/Veteran

Annual