Job Ref: 118347
Category: Compliance and Regulatory
Department: OFFICE CORPORATE COMPLIANCE
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $65,000.00
Salary Range: $65,000.00 - $75,000.00
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
MetroPlusHealth 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, MetroPlusHealth 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
Empower. Unite. Care.
MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
The Federal & Integrated Products Materials Reviewer plays a critical role in supporting the Regulatory Operations team by managing regulatory requirements related to Medicare and MAP materials. This position is responsible for the ongoing oversight, analysis, review, and approval of all beneficiary- and provider-facing Medicare and MAP materials.
The materials reviewed may include flyers, brochures, trifolds, text messages, member notices, the Annual Notice of Change, Enrollment Request Forms, Summaries of Benefits, Evidence of Coverage documents, and more. These materials serve various purposes, including outreach, potential enrollment activities, and educating current members about the services offered.
This role primarily operates remotely with in-office presence only as needed for key meetings, collaboration, or business needs.
Conducts detailed review of member and prospective member communications against CMS regulations to ensure compliance and provides professional feedback to material owners
Analyze all Medicare and MAP related marketing materials for compliance with CMS Marketing guidelines
Submit all needed materials to CMS for review and approval via HPMS
Maintain up-to-date knowledge of all Centers of Medicare & Medicaid (CMS) regulations
Collaborate with the Product team to ensure the accuracy of benefit information and clarity of language
Partner with operational business units to support the creation, submission, and approval of marketing materials during the Annual Enrollment Period (AEP)
Collaborate closely with the Regulatory Materials Reviewer on communications related to IB-Duals Group and MAP.
Assist in maintaining a comprehensive repository of all material reviews, including documentation of review and inquiry responses within the SharePoint site, and saving copies of all relevant documents and communications.
Assign final codes to all materials reviewed and approved internally and externally by CMS.
Other duties and responsibilities as assigned by the Regulatory Operations Manager.
Bachelor’s Degree required.
5 years’ of Managed Care experience, with a focus on Medicare and Integrated Programs required.
A satisfactory equivalency in education, training, and experience.
Experience with Medicare and CMS Regulations required.
Experience with the creation, submission and approval of CMS marketing materials.
Experience managing multiple requests and keeping track of incoming requests and tracking deadlines.
Team player, willing to collaborate and provide guidance to cross-functional teams.
Ability to manager multiple projects under tight deadlines and strong attention to deal.
Proficiency in Microsoft Suite, including SharePoint.
Professional Competencies
Excellent written and oral communication skills
Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team
Organizational skills
Sound working knowledge of Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools
Creative problem-solving abilities
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