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Sanford Health Director Regulatory Affairs - Health Plan - Governmental Affairs in Sioux Falls, South Dakota

Job Title: Director Regulatory Affairs - Health Plan | Governmental Affairs | Sioux Falls

City: Sioux Falls

State: SD

Department : Governmental Affairs - Sioux Falls

Job Schedule: Full Time

Shift: Days

Hours Per Shift: 8 hr

JOB SUMMARY

Represents health plan and

functions as a single point of contact with representatives of state,

regulatory and enforcement agencies to ensure effective communication and

partnerships.

Coordinates with various internal

health plan departments and committees to assure operational and procedural

compliance with state and federal regulations. Responsible for working with

regulators to resolve misunderstandings and seek clarity on the application of

various insurance laws and regulations.

Tracks new laws and regulations

impacting health plan in coordination with government affairs and supports

change to ensure compliance. Oversees data collections, analysis and

presentation for compliance related reports required, as well as triage complex

compliance issues escalated by staff.

Coordinates with Sanford Health's

public policy team to ensure consistent messaging and priorities for the health

plan and enterprise.

Monitors, analyzes and informs

leadership and critical internal customers of key state legislative

developments relating to coverage, access or reimbursement. Provides

comprehensive assessment of potential impact on Sanford Health Plan operations.

Regularly and clearly communicates

the impact of policy developments on business goals and strategies to all

relevant stakeholders. Partners with patient access, compliance, reimbursement,

operations, legal teams and other key internal customers to advise on key

business strategies. Supports alignment with policy goals.

Establishes constructive

relationships with key resource groups in the community, e.g., key political

leaders, community officials, the business community, media personnel,

volunteers, related health and service agencies, donors, other system

personnel, medical staff and all other individuals or groups essential to the

organization's continued progress and growth. Reviews departmental goals and

objectives annually.

Has latitude to make changes to

job assignments and commit resources to longer-term projects or initiatives.

Collaborates with operations to review, analyze and develop initial

implementation project plans and/or corrective action plans to ensure

compliance with new or existing laws, regulations and customer and

accreditation requirements. Participates in legislative sessions and committee

meeting hearings. Participates in trad associations and community events.

Manages and supports audits and

implementations to ensure regulatory requirements are satisfied. Tracks and

analyzes all new regulatory requirements pertaining to public sector and

commercial lines of business. Prepares summaries of analysis that include, as

appropriate, relevant legislative history, comparisons to existing or proposed

legislation in other jurisdictions and detailed descriptions of the operational

requirements and affected departments. Consults and coordinates with new

business/sales/product development to determine all regulations pertaining to

any products being offered in the marketplace. Reviews benefit plans for

compliance with state mandates.

Promotes cooperation and

collaboration between internal departments and fosters positive interactions

with individuals, agencies and/or institutions. Involves colleagues and

subordinates in activities, as appropriate, to accomplish planning and

marketing strategies. Must have a keen sense of diplomacy, effective

communication, marketing and planning skills. Must have excellent analysis,

synthesis, and implementation skills. Must be able to recognize and solve

problems. May require overnight travel, as needed.

POSITION RESPONSIBILITIES

Accurately analyzes issues and determines who needs to be consulted or kept informed. Influences high-impact, high-risk and highly complex situations. Evaluate programs and policies, and make related recommendations to institutions and organizations. Debates issues to bring the most critical points to the forefront for decision making. Cultivates effective cross-boundary relationships focused on shared strategic interests. Confer with colleagues to formulate positions and strategies pertaining to pending issues. Analyze and understand the local and national implications of proposed legislation. Recognizes and effectively addresses politically challenging situations. Oversee expense allowances, ensuring that accounts are balanced at the end of each fiscal year. Maintain current knowledge of government policy decisions. Interpret and analyze policies, public issues, legislation, or the operations of governments, businesses, and organizations.

DEPARTMENT DETAILS

Not required at this time.

QUALIFICATIONS

Bachelor's degree in healthcare administration, business, public policy/administration, governmental relations,

or related field required. Master's degree preferred. Minimum five years' experience in a healthcare regulatory environment required, preferably in managed care or compliance.

Five years of management/leadership experience required.

Experience in a legal or legislative environment. Expert level of knowledge of regulatory environments, health plan care operations

and compliance challenges in health care/managed care industry. Advanced level

of knowledge and experience with Health Insurance Portability and

Accountability (HIPAA), state privacy laws and healthcare.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.

Every day, we show that commitment by delivering the highest quality of care to the communities we serve.

We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth.

We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.

We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities.

We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application,

please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

City: Sioux Falls

State: SD

Job Function: External Affairs

Job Schedule: Full Time

Shift: Days

Req Number: WD15013

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