Providence Health & Services Director - Commercial Compliance & Regulatory Affairs in Beaverton, Oregon
Providence St. Joseph Health is calling a Director - Commercial Compliance & Regulatory Affairs to our location in Beaverton, OR.
This position is remote with occasional travel to internal meetings.
We are seeking a Director - Commercial Compliance & Regulatory Affairs to be responsible for managing and developing a team tasked with performing regulatory consulting, compliance oversight, and compliance program development for Providence Health Plan's commercial lines of business (i.e. employer group markets, individual and family including exchanges, ancillary products). Responsible for managing interpretation and dissemination of state and federal regulatory requirements. Oversees Qualified Health Plan compliance and regulatory functions. Develops, manages and communicates internal subject matter expertise regarding the foregoing functions and acts as a consultant to leadership and staff at PHP. Acts as key point of contact with CMS and state exchange entities regarding PHP federal exchange participation. The work of the Director – Commercial Compliance & Regulatory Affairs impacts PHP's legal and regulatory obligations as well as financial obligations to Providence Health Plan customers.
Performs all duties in a manner that promotes a team concept.t and reflects the Sisters of Providence mission and philosophy.
In this position you will have the following responsibilities:
Responsible for managing staff, including hiring, coaching, development, and discipline.
Work closely with senior leadership to lead the development and maintenance of the plan's compliance program for commercial lines.
Leads PHP's efforts to ensure compliance with state and federal statutes, regulations, and contractual requirements with respect to PHP commercial lines of business.
Manages the interpretation and dissemination of state and federal guidance regarding commercial health plans to PHP leadership and staff, while considering continuously changing regulatory landscape.
Reports in to the Providence Health Plan compliance committee and prepares materials for board compliance committee.
Oversees the development and continual improvement of PHP compliance structures regarding commercial products, including development of documented policies and adherence to requirements related to downstream delegated entities.
Develops and delivers training and educates internal and external audiences regarding federal and state legal and regulatory requirements.
Responsible for fostering and maintaining the compliance relationship between PHP compliance staff and CMS Region 10 account management personnel.
Oversees various regulatory filing requirements (including product filings) and contracting processes in support of commercial lines of business.
Review all insurance filings and advise on key contracts as requested.
Negotiate and defend market conduct and enforcement activity by state and federal regulators.
n support of the Government Affairs Manager, participate in development of PHP's policy/advocacy response to legislators and other state and/or Federal officials relating to proposed bills, legislation or regulations.
Triage matters to departmental colleagues or legal counsel regarding contracts, legal issues, and risk management as necessary.
Performs other projects and duties as assigned.
Required qualifications for this position include:
Bachelor's Degree in Healthcare Administration, Business, Public Administration, Government, or related field.
Five (5) years of work experience in the in the areas of regulatory compliance or oversight, auditing, risk management, litigation support or government relations.
Five (5) years of Management experience; this requirement may be fulfilled via oversight of legal assistants or paralegals.
Preferred qualifications for this position include:
Master's Degree or equivalent education/experience.
Five (5) years managed care or health insurance experience.
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Lead/Supervisor/Manager
Other Location(s): California, Washington
Req ID: 316824