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Director of Eligibility Regulatory Compliance

MassHealth is seeking qualified applicants for the position of Director of Regulatory Compliance. The MassHealth Director of Eligibility Regulatory Compliance reports directly to the MassHealth Deputy Chief Operating Officer for Eligibility Policy & Implementation. The Director of Eligibility Regulatory Compliance will be responsible for creating, reviewing, and overseeing the execution of effective compliance strategies that will ensure our eligibility operations and business practices are aligned with the overarching requirements of applicable state and federal laws. This includes anticipating possible compliance risks and devising solutions that will minimize any adverse effects.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
  • Develop and implement compliance policies and procedures, including methods to adequately ensure compliance with state and federal laws, regulations, and best practices.
  • Maintain internal company procedures to ensure that our staff is kept up-to-date regarding any modifications to existing compliance laws and policies.
  • Revise policies and procedures as needed to address changes in law.
  • Monitor for potential compliance violations and risk.
  • Work closely with the General Counsel and Operations staff to identify process efficiencies.
  • Conduct compliance reviews to assess alignment with critical policies, procedures, and regulations and recommend corrective action, including training.
  • Work closely with staff to ensure that compliance is integrated into daily activities.
  • Keep up to date on compliance and regulatory requirements and identify and develop effective compliance tools and resources.
  • Develop creative compliance education tools and activities such as email blasts, portal and newsletter postings.
  • Other duties, as assigned.
Preferred Qualifications:
  • Legal and Regulatory Knowledge: Understanding of state and federal laws, regulations, and compliance requirements relevant to the organization’s industry.
  • Policy Development and Implementation: Ability to develop, review, and implement comprehensive compliance policies and procedures.
  • Risk Management: Skill in identifying potential compliance violations and implementing proactive measures to mitigate risks.
  • Collaboration and Communication: Strong communication and collaboration skills to work closely with legal counsel, operational teams, and senior leadership.
  • Strategic Thinking: Ability to think strategically and align compliance initiatives with overall organizational goals and objectives.
  • Training and Education: Skill in developing and implementing effective compliance training programs and educational tools for staff.
  • Problem-Solving: Strong problem-solving skills to address compliance challenges, conduct reviews, and recommend corrective actions.
  • Adaptability and Flexibility: Ability to adapt to changes in laws and regulations, and flexibility to handle unforeseen compliance issues.
  • Process Optimization: Skill in collaborating with operational teams to identify and implement process efficiencies without compromising compliance standards. Strong working knowledge of MassHealth eligibility policies and internal member operations, including member data information systems.

TO APPLY:

Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.

About MassHealth:

The mission of MassHealth is to improve the health outcomes of our diverse members, their families, and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life.

For more information about our agency and programs please visit: www.mass.gov/masshealth

Pre-Offer Process:

A criminal and tax history background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure, and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the Reasonable Accommodation Online Request Form..

For questions, please contact the Office of Human Resources at 1-800-510-4122 and select option #4.

Qualifications

MINIMUM ENTRANCE REQUIREMENTS:

Applicants must have at least (A) six (6) years of full-time or, equivalent part-time, professional, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management of which (B) at least two (2) years must have been in a supervisory or managerial capacity or (C) any equivalent combination of the required experience and substitutions below.

Substitutions:

I. A certificate in a relevant or related field may be substituted for one (1) year of the required (A) experience.

II. A Bachelor’s degree in a related field may be substituted for two (2) years of the required (A) experience.

III. A Graduate degree in a related field may be substituted for three (3) years of the required (A) experience.

IV. A Doctorate degree in a related field may be substituted for four (4) years of the required (A) experience.

Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don’t meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.

Official Title: Administrator VIII
Primary Location: United States-Massachusetts-Quincy – 100 Hancock Street
Job: Administrative Services
Agency: Exec Office Of Health and Human Services
Schedule: Full-time
Shift: Day
Job Posting: Apr 24, 2025, 11:24:01 AM
Number of Openings: 1
Salary: 107,613.69 – 166,302.18 Yearly
If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator: Kendy Derival, [email protected] – 6173488456
Bargaining Unit: M99-Managers (EXE)
Confidential: No
Potentially Eligible for a Hybrid Work Schedule: Yes

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