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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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Administrator, Regulatory Compliance (Workpartners)

  • Job ID: 505179785
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Commercial Compliance
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $33.86 to $57.80 / hour

Description

UPMC Health Plan's rockstar Compliance team is seeking an Administrator, Regulatory Compliance to support UPMC Workpartners! 


Under the direction of the Corporate Compliance 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 organizations. Incumbent functions as liaison with appropriate state agencies, oversees all regulatory filings, reporting, and coordinates service area expansions.

WP Compliance has assumed responsibility for researching all regulatory and monitoring regulatory reporting from Corporate Compliance in all states outside Pennsylvania where Workpartners acts as a workers’ compensation insurer (MD/DE/WV/NJ). 

This role will be a hybrid role (work from home/ US Steel in downtown Pittsburgh). APPLY TODAY!

Responsibilities:

 

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

 

Qualifications

  • Bachelor's degree required.
  • Juris Doctor, compliance experience, and legal research are strong preferences
  • Five (5) years of health insurance, government products, or regulatory review are required.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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