Senior Regulatory Specialist – Medicaid/CHIP - JHP

Job Details

The Regulatory Specialist II is responsible for ensuring compliance with all state and federal regulatory requirements affecting Pennsylvania’s HealthChoices (Medicaid managed care) and CHIP programs. This role serves as a key liaison with the Pennsylvania Department of Human Services (DHS), Office of Medical Assistance Programs (OMAP), Bureau of CHIP, and other oversight entities.



This position is responsible for monitoring regulatory developments and policy changes, analyzing their impact on business operations, managing contract deliverables, and collaborating with internal stakeholders to operationalize requirements and maintain compliance with DHS and state mandates.  The ideal candidate has a strong understanding of health insurance laws (e.g., ACA, HIPAA, CMS, state DOI regulations) and experience working with regulatory bodies.

Job Description

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Monitor federal and state regulatory changes, analyzing operational impact and providing analysis for internal stakeholders, including internal training, dissemination and distribution of regulatory communications to affected business units.
• Interpret contract requirements, working with cross-functional teams to advise on implementation of new programs and initiatives.
• Support new Medicaid/CHIP implementations and renewals, including participation in readiness and operational reviews, RFP responses, and annual redetermination cycles.
• Prepare and ensure timely and accurate regulatory submissions, such as contract deliverables, policy updates, readiness review materials, and state-required filings.
• Collaborate with internal departments to ensure product benefits and communication materials meet requirements.
• Maintain detailed documentation and tracking systems for regulatory correspondence, contract deliverables, deadlines, and filing status.
• Draft and update compliance policies and procedures specific to regulatory department.
• Assist in internal training and awareness efforts, providing regulatory interpretation. 
• Serve as a liaison between the company and regulatory agencies.
• Participate in internal policy development and review processes to ensure alignment with Pennsylvania Medicaid/CHIP rules and CMS guidance under 42 CFR Part 438.
• Serve as a subject matter expert (SME) for Pennsylvania-specific regulatory requirements and provide training and guidance to internal teams.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

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.

AND

Experience:

• 3–5+ years of experience in regulatory, compliance, or policy roles within Medicaid managed care or government-sponsored health plans.
• Strong understanding of Medicaid and CHIP regulatory frameworks, including state Medicaid contract requirements and federal rules under 42 CFR Part 438.
• Experience preparing or managing submissions to state Medicaid agencies and CMS, including audit responses and deliverables tracking.

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.