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Medicare Regulatory Specialist, Sr Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1000297
Categories:  For-Profit Senior Services
Job Role:  Legal / Legal Assist / Juris Doctor (JD)
Region/Province:  Florida (FL)
City:  FL-Tampa
Job Description:  !*!About WellCare: We provide managed care services targeted exclusively to government-sponsored health care programs, focused on Medicaid and Medicare, including prescription drug plans and health plans for families, and the aged, blind and disabled. As of March 31, 2009, we served nearly 2.5 million members. Our experience and our exclusive commitment to these programs enable us to serve our members and providers, and to manage our operations efficiently.

Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the Company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national PDP provider and the largest Medicaid plan in Georgia. Today WellCare has grown to be the eighth largest publicly traded health care plan in the country with 3,800 associates and nearly 2.5 million members nationwide.
Participates in one or all of the following:  the oversight of Medicare Advantage and Part D Regulatory Affairs company-wide, the thorough integration of WellCare's corporate ethics and compliance program, the Trust Program, the ongoing oversight and analysis regional regulatory compliance and the review and approval of all marketing materials.

 

Essential Functions:


  • Performs comprehensive, complex regulatory analyses, including the review, summarization and dissemination of key regulatory updates and changes.

  • Drives the policy and procedure process, including the design, review, cataloguing, dissemination and annual updating of corporate policies and procedures.

  • Coordinates site visits by Federal and State regulators.  This function involves developing work plans, collecting deliverables, reviewing and quality checking deliverables, mock interviews, and site visit facilitation.

  • Develops regulatory process flows, including the documentation of departmental processes, report generation, and process improvement.

  • Provides project leadership for compliance-related audits, including the review of departmental documents, interview of departmental staff, summarizing results and implementing recommendations.

  • Supports the design, development and implementation of the Regulatory database.  Ensures all key departmental processes are captured in the database for tracking and trending purposes.

  • Supports the management of the regulatory communications process.  Ensure all regulatory communications/updates are received, summarized, catalogued, disseminated and acted upon.

  • Coordinates the filing of regulatory forms, reports, etc. Provides guidance to other departments in understanding and complying with regulatory requirements. This includes researching regulations, informing departments of regulations, and assisting as needed in developing procedures to comply, as well as drafting responses to queries by regulatory agencies.

  • Tracks all issues referred to the Regulatory Affairs Department up to and including resolution.

  • Represents the health plan at federal, state, and local government meetings.

  • Performs special projects as assigned.

Education:  A Bachelor's Degree in work related field      

 

Experience:  5 years direct Medicare health experience with a focus on compliance and/or regulatory functions.  Previous State or Federal managed care compliance experience preferred.  Solid knowledge of Medicare and Medicaid programs preferred. Previous State or Federal managed care compliance experience. 

 

Special Skills (e.g. 2nd language): 

Experience in reading, analyzing and interpreting State and Federal laws, rules and regulations

Maintains a high degree of credibility, independence, integrity, confidentiality and trust

Strong writing, communication and presentation skills

Ability to develop partnerships, and good working relationships

Ability to work within team framework and alone 

Good analytical skills and an understanding of operational processes and regulatory requirements

Ability to operate successfully in a constantly changing, fast-paced environment

Demonstrates self-motivation, initiative, practical learning skills, enthusiasm and an ability to complete multiple tasks in a timely and accurate manner 

 

Technical Skills/Requirements:  Knowledge in Microsoft Office including Access, Excel and Word
Post Date:  08/07/2010
 

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