Commercial Regulatory Guidance Specialist / Remote / NYC Area
Job title: Commercial Regulatory Guidance Specialist / Remote / NYC Area in New York City, NY at RCM Health Care Services
Company: RCM Health Care Services
Job description: Commercial Regulatory Guidance Specialist – Remote / NYC Area
Schedule: Monday through Friday, standard business hours
Location: Remote with occasional in-office presence in NYC for key meetings
Salary: Up to $100,000 + excellent benefitsAbout the Organization
We are a mission-driven health plan serving communities across the five boroughs of New York City. Our organization offers a comprehensive range of products, including Medicaid Managed Care, Medicare, Child Health Plus, Qualified Health Plans, Essential Plan, and more. With a robust network of providers and a deep commitment to quality care, we’ve been a trusted healthcare partner for over 30 years.Position Overview
The Commercial Regulatory Guidance Specialist plays a vital role in ensuring compliance for our Qualified Health Plans (QHP), Essential Plan (EP), Child Health Plus (CHP), and large group products. Reporting to the Director of Regulatory Compliance, this role involves interpreting complex healthcare regulations, guiding internal teams, and conducting compliance reviews and risk assessments. This is an ideal opportunity for someone with deep knowledge of healthcare policies who thrives in a collaborative environment and is passionate about ensuring quality, accessible care for all.Key Responsibilities
- Ensure ongoing compliance with ACA, CMS, and state-specific regulations for commercial health insurance products.
- Provide regulatory guidance to cross-functional teams including sales, marketing, product development, and leadership.
- Conduct internal compliance reviews, risk assessments, and audits.
- Monitor and communicate changes in federal and state regulatory guidance.
- Support departments in conducting root cause analyses and implementing corrective action plans.
- Drive the implementation of new regulatory requirements across operations.
- Assist with preparation for internal compliance committees and board subcommittees.
- Coordinate audit responses and ensure timely corrective actions post-audit.
- Review and help enhance internal policies, procedures, and operational metrics to maintain regulatory alignment.
- Perform other related duties as assigned.
- Bachelor’s degree required.
- Minimum of 3 years of experience in managed care or a related healthcare compliance field.
- Relevant certifications such as CHC or CCEP are a plus.
- Strong knowledge of healthcare regulations, including ACA, CMS, and state-specific rules for public and commercial health plans.
- Demonstrated ability to lead interdepartmental initiatives and manage multiple projects.
- Skilled in translating complex regulatory language into actionable operational guidance.
- Excellent communication, writing, and analytical skills.
- High level of professionalism and discretion when handling sensitive or confidential information.