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General Purpose of Job:

The Driscoll Health Plan (“DHP”) Director of Regulatory Operations is responsible for the development, implementation, and oversight of an effective regulatory program for DHP. In this role, the Director will be instrumental in the coordination, communication and guidance to internal stakeholders regarding applicable State and Federal rules and regulations and State contractual requirements. The Director is also responsible for professional engagement with regulators in order to communicate the needs of DHP, as well as, to coordinate responses to requested regulatory deliverables such as government filings for the Texas Health and Human Services Commission (“HHSC”), Texas Office of Inspector General (“OIG”), Texas Department of Insurance (“TDI”), as well as other regulatory agencies as needed.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or administration as required.

Acts as an expert managed care resource for DHP internal stakeholders regarding state and federal regulations that may affect DHP and provides guidance when regulatory reports and deliverables are requested.
Monitors and interprets new and revised Texas Uniform Managed Care Contract (“UMCC”) and Uniform Managed Care Manual (“UMCM”) requirements and communicates applicable changes to internal DHP stakeholders.
Develops and oversees a robust delegated oversight program which includes auditing and monitoring of DHP delegated entities as well as the implementation and monitoring of delegated entity corrective action and remediation plans.
Oversees the development, tracking and submission of reports, regulatory filings, and audits to HHSC, OIG, TDI and other regulatory agencies on behalf of DHP.
Establishes and maintains collaborative relationships with applicable external regulatory agency representatives.
Oversees the coordination, communication and response from internal stakeholders regarding questions or clarifications related to guidance or administrative directives provide by regulatory agencies.
Represents DHP in regular and ad-hoc regulatory agency oversight meetings.
Represents DHP in scheduled or ad-hoc HHSC, Texas Association of Health Plans (“TAHP”), Texas Association of Community Health Plans (“TACHP”) and other applicable collaborative meetings in order to track and share information and guidance with DHP Leadership that could inform operational decision making.
Oversees the DHP contract management process.
Mentors, develops and imparts knowledge to aid regulatory staff development, ensure cross-coverage so that the regulatory team and departmental operations remain agile and effective.
Other duties as reasonably assigned.

Supervisory Responsibilities:

Effectively administers performance management system including: Developmental feedback, Goal setting, Assesses competency, Progressive discipline
Makes and implements decisions compatible with organizational goals.
Maintains confidentiality, composure, effectiveness, and flexibility under pressure.

Education and/or Experience:

JD, paralegal certificate, or equivalent legal training strongly preferred.
Work experience in managed care, health plan operations, or regulatory oversight is a plus.
Bachelor’s Degree required.
Alternatively, any combination of education and experience, which would provide an equivalent background.

Driscoll Health

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