Job Description

Job Title: Administrator, Regulatory Compliance- Commercial
Job ID: 723516
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Compliance & Ethics
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
The Administrator, Commercial Compliance reports to the Sr. Director, Commercial Compliance. This position strategically ensures compliance with all relevant and applicable Commercial laws, regulations, contractual agreements, standards and requirements in a manner that continually supports the business and operational areas.

Responsibilities:
  • As requested by key UPMC-HP management staff, works on responses to RFPs and grant programs for government programs
  • Assists the Corporate Compliance Office with the Compliance Committee, Policy & Procedure Committee, Policy & Procedure Subcommittee and Compliance training.
  • Leads project teams for compliance.
  • 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
  • Provides direct supervision of staff.
  • Reports on a weekly basis status of all assignments pertinent information obtained during report week. Provides projections for upcoming week.
  • Reviews drafts and/or drafts (as requested) policies and procedures from compliance perspective and maintains required Corporate policies and procedures
  • Updates key management staff of regulatory changes/developments and implications of new health care legislative initiatives on functional areas of UPMC Insurance Services Division.
  • Works with Senior Director of Compliance and designated departments to coordinate compliance monitoring
  • Works with UPMC-HP staff on review of proposed health care legislation and implementation schedules for newly enacted health care legislation and regulations

Qualifications

  • Bachelors 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. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $30.89 to $52.76

Union Position: No

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