Job Description

Job Title: Administrator, Regulatory Compliance
Job ID: 728641
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:
UPMC Health Plan is seeking an Administrator- Regulatory Compliance!

 

Under the direction of the Senior Director of the Corporate Compliance & Ethics 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 and worker’s compensation organizations. Incumbent functions as liaison with appropriate state agencies, oversees all regulatory filings, reporting, licensing and coordinates service area expansions.

 

• Law background preferred
• Previous experience researching and analyzing managed care and worker’s compensation laws and regulations preferred
• Previous experience drafting/modifying policies and procedures to meet regulatory standards preferred
• Previous experience translating regulatory or technical standards into simple, clear written instructions preferred


Responsibilities:
• Coordinates obtaining licenses to offer health plans and worker’s compensation in new states (e.g., HMO, PPO, third party administration, utilization review)
• Researches state laws and regulations related to licensure
• Assist business units to incorporate expansion state regulatory requirements into operating policies and procedures
• Oversee preparation of quarterly and annual regulatory reports required by license
• Reviews drafts and/or drafts (as requested) policies and procedures from a regulatory/compliance perspective
• Updates key management of regulatory changes/developments and implications of new health care, worker’s compensation legislative initiatives to the functional areas of UPMC Insurance Services Division.
• Works with Senior Director of Compliance and designated departments to coordinate compliance monitoring

Qualifications

  • Bachelors degree required.
  • Masters degree and/or paralegal certificate preferred.
  • Previous management/supervisory experience preferred.
  • Five 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

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

Learn more about working here and check out our policies and recent updates.

Share:
Talent Network