Job Details

The Manager, Regulatory (Medicare Advantage and ACA) serves as a strategic, forward-thinking compliance leader, ensuring the organization meets all federal and state regulatory requirements for Medicare Advantage and ACA-compliant individual and small group health plans. This role is pivotal in interpreting complex regulations, shaping organizational responses, and driving innovative, results-oriented implementation strategies that safeguard compliance and support business objectives.

As a visionary and trusted advisor, they proactively monitor evolving regulatory landscapes, evaluates policy impacts on operations, and leads the organization in oversight and preparation of filings and communications with oversight agencies such as CMS and state Departments of Insurance (DOIs). The position requires and empathetic, collaborative, and diplomatic approach, partnering closely with internal stakeholders to interpret regulatory changes, operationalize requirements, mitigate risk, and maintain adherence to CMS and state mandates.

The ideal candidate is a highly analytical, meticulous, and resilient professional with deep expertise in health insurance regulations including ACA, HIPAA, CMS, and state DOI requirements and proven experience engaging with regulatory bodies. This individual combines strategic insight, strong communication skills, and execution excellence, serving as an influential leader who ensures compliance while enabling organizational growth.

This role is responsible for managing day-to-day regulatory activities, coordinating submissions, and ensuring operational adherence to complex federal and state regulations. Reporting to the Director of Regulatory Affairs, the Manager will lead a team of regulatory analysts, oversee project execution, and serve as a key resource for regulatory interpretation and guidance within the organization.

Job Description

Minimum Education and Experience Requirements:
 

Education:

• Bachelor’s degree in public health, Business Administration, Health Policy, Law, or a related field.
• Juris Doctor (JD) or Master’s degree in a relevant field is a plus.
  
  Experience:
• 5-7 years of experience in a regulatory or compliance role within the health insurance, healthcare, or managed care industry.
• Knowledge of applicable federal and state health insurance regulations, including ACA, CHIP, HIPAA, Medicare, and Medicaid.
• Experience dealing with regulatory agencies such as CMS and state DOIs.
• A strong understanding of ACA and Medicare benefits and regulations, including QHP and Medicare Advantage requirements and state/federal Exchange operations.
• Experience preparing or supporting CMS and DOI filings is strongly preferred.
• Strong leadership skills with experience managing or mentoring team members. 
• Excellent organizational, analytical, and project management skills. 

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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