Regulatory Affairs Associate – Managed Long Term Care (MLTC)

Compensation: $150K–$170K per year

Job Type: Monday through Friday, 9:00 AM to 5:00 PM. This role will be fully onsite for the first 90 days during the probationary period. After that, the position transitions to a hybrid schedule: 3 days in the office and 2 days remote.

Our client, is seeking a Regulatory Affairs Associate to support and coordinate compliance activities within its health plan operations. This position plays a critical role in ensuring regulatory alignment across various programs, contracts, and legal matters, including CMS, DOH, OIG, and OMIG compliance.

Responsibilities

• Draft, review, and negotiate provider and organizational agreements in accordance with internal policies and compliance standards.
• Lead and manage data collection and submissions for external audits, surveys, and government requests.
• Oversee provider contracting processes and manage follow-up communications.
• Administer Fair Hearing (FH) cases, including calendar management, case prep, documentation, and hearing attendance.
• Handle regulatory reports and provide updates on ongoing cases and investigations.
• Participate in Special Investigation Unit (SIU) functions, including compliance reporting and internal investigations.
• Update HIPAA-related policies and procedures to ensure compliance with current regulations.
• Maintain awareness of and ensure adherence to OIG and OMIG compliance practices and requirements.
• Review state and federal plan contracts to ensure consistency with regulatory standards.
• Distribute and interpret CMS and DOH updates, memos, and official regulatory guidance.
• Coordinate document production in response to legal matters or litigation requests.
• Maintain internal databases related to provider credentials and other compliance documentation.
• Draft and revise internal policies, procedures, manuals, and member-facing plan materials.
• Supervise and provide oversight to department support staff.

Requirements

• Juris Doctor (JD) from an accredited institution
• Must be a Licensed Attorney
• Minimum of 3 years’ experience in managed care compliance, credentialing, or contracting
• Familiarity with MLTC, MAP, Medicaid, Medicare program regulations
• Demonstrated leadership or supervisory experience
• Strong legal and analytical skills related to contract review and compliance oversight
• Proven ability to handle investigations and recommend practical solutions

Benefits

• Medical 
• Dental 
• Vision
• 403B with employer match
• Life insurance 
• Flexible Spending Account 
• Employee Assistance Program (EAP)
• Pet insurance
• Tuition Reimbursement Program
• PTO