Federal & Integrated Products Materials Reviewer

Job Ref: 118347 Category: Compliance and Regulatory Department: OFFICE CORPORATE COMPLIANCE Location: 50 Water Street, 7th Floor, New York, NY 10004 Job Type: Regular Employment Type: Full-Time Hire In Rate: $65,000.00 Salary Range: $65,000.00 - $75,000.00 Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. About NYC Health + Hospitals MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. Position Overview Empower. Unite. Care. MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day. The Federal & Integrated Products Materials Reviewer plays a critical role in supporting the Regulatory Operations team by managing regulatory requirements related to Medicare and MAP materials. This position is responsible for the ongoing oversight, analysis, review, and approval of all beneficiary- and provider-facing Medicare and MAP materials. The materials reviewed may include flyers, brochures, trifolds, text messages, member notices, the Annual Notice of Change, Enrollment Request Forms, Summaries of Benefits, Evidence of Coverage documents, and more. These materials serve various purposes, including outreach, potential enrollment activities, and educating current members about the services offered. This role primarily operates remotely with in-office presence only as needed for key meetings, collaboration, or business needs.

Job Description

• Conducts detailed review of member and prospective member communications against CMS regulations to ensure compliance and provides professional feedback to material owners
• Analyze all Medicare and MAP related marketing materials for compliance with CMS Marketing guidelines
• Submit all needed materials to CMS for review and approval via HPMS
• Maintain up-to-date knowledge of all Centers of Medicare & Medicaid (CMS) regulations
• Collaborate with the Product team to ensure the accuracy of benefit information and clarity of language
• Partner with operational business units to support the creation, submission, and approval of marketing materials during the Annual Enrollment Period (AEP)
• Collaborate closely with the Regulatory Materials Reviewer on communications related to IB-Duals Group and MAP.
• Assist in maintaining a comprehensive repository of all material reviews, including documentation of review and inquiry responses within the SharePoint site, and saving copies of all relevant documents and communications.
• Assign final codes to all materials reviewed and approved internally and externally by CMS.
• Other duties and responsibilities as assigned by the Regulatory Operations Manager.

Minimum Qualifications

• Bachelor’s Degree and 5 years of Managed Care experience, with a focus on Medicare and Integrated Programs required; or
• Associate’s Degree and 7 years of Managed Care experience, with a focus on Medicare and Integrated Programs required; or
• High School Diploma or equivalency and 9 years of Managed Care experience, with a focus on Medicare and Integrated Programs required; or
• A satisfactory equivalent combination of education, training, and no less than 2 years of relevant experience.
• Must be familiar with the Annual Enrollment Period (AEP) material review process.
• Experience with the creation, submission and approval of CMS marketing materials.
• Experience managing multiple requests and keeping track of incoming requests and tracking deadlines.
• Team player, willing to collaborate and provide guidance to cross-functional teams.
• Ability to manage multiple projects under tight deadlines and strong attention to deal.
• Proficiency in Microsoft Suite, including SharePoint

Professional Competencies

• Excellent written and oral communication skills
• Excellent interpersonal skills with a high level of diplomacy and political awareness, and ability to work effectively as a member of the senior management team
• Organizational skills
• Sound working knowledge of Word, Excel, PowerPoint, SharePoint, and Visio as well as online/Internet-based research tools
• Creative problem-solving abilities

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