Compliance Program Consultant, Mental Health Parity

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

This position provides mental health parity compliance support to all lines of Medica's business. This role partners with business units, particularly those aligned under Health Services, to ensure compliance with applicable state and federal mental health parity regulations, including the requirements to ensure financial requirements, quantitative treatment limitations, and non-quantitative treatment limitations are designed and applied no more stringently for mental health/substance use services than medical/surgical services. The consultant also contributes to enterprise risk assessments, facilitates the implementation of regulatory changes pertaining to mental health parity with external partners, and leads or supports other compliance activities such as federal regulatory investigations and state market conduct exams. Operating at a senior professional level, this role exercises decision-making authority and serves as a key resource in navigating complex compliance projects.

The individual will be responsible to maintain and review regulatory documentation necessary to maintain corporate standards which includes maintenance and implementation of department policies, procedures, and work processes. This individual will work closely with other members of the Mental Health Parity (MHP) Team and will partner with business leads and subject matter experts across the organization to establish and maintain the tenets of the mental health parity program and execute related activities accurately and timely. This position will serve as the primary point of contact for Health Services to provide guidance to internal partners and will assist with mental health parity efforts of the compliance program. Performs other duties as assigned.

Key Accountabilities

• Compliance Adherence
  
  
  
  • Partner with internal business areas and external vendors to ensure compliance with mental health parity's requirements for Quantitative Treatment Limitations, Non-Quantitative Treatment Limitations, and Financial Requirements
  • Draft and update the Non-Quantitative Treatment Limitation Comparative Analysis for multiple states with a focus on clinical NQTLs
  • Assists partners with implementation of new laws or regulations related to mental health parity
  • Act as a resource for mental health parity questions and training
  • Assists in the maintenance and implementation of department policies, procedures, and work processes
  
  
  
  
• Regulatory Filings
  
  
  
  • Prepare mental health parity filings for regulators in multiple states; coordinate submission of responses to questions/objections regarding the filings
  • Participate in the product development process to ensure products comply with mental health parity prior to the products being filed with regulators for approval
  
  
  
  
• Audit Support
  
  
  
  • Participate in mental health parity-focused internal and external investigations, market conduct examinations, and audits (collectively, "audits")
  • Respond to document requests for audits
  • Conduct extensive audit research
  • Prepare comprehensive analyses and audit reports
  
  
  
  
• Monitor & Report
  
  
  
  • Conducts assigned special projects, provides program support, and performs reporting.
  • Assists in the maintenance and implementation of department policies, procedures, and work processes.
  
  
  
  

Required Qualifications

• Bachelor's degree or equivalent experience in related field
• 5 years of experience beyond degree

Preferred Qualifications

• Knowledge of healthcare regulations and compliance program, or demonstrated logic and reasoning abilities and growth mindset
• Knowledge of general health plan operations, technology delivery, and vendor management highly desirable
• Demonstrated knowledge of health care laws and regulations, including Medicare and Medicaid, or demonstrated ability to read and apply complex written material
• High standard of ethics, responsibility, discipline, and professionalism
• Excellent conceptual thinking skills to analyze complex and sensitive issues and implement solutions
• Excellent written and oral communication, presentation, problem-solving, and analytical skills
• Proven ability to communicate effectively with all levels of an organization
• PMP or other project management certification is a plus
• Demonstrated ability to work well as a team; desire to contribute to a high-performing team
• Must be able to appropriately challenge "conventional wisdom"
• Must be able to develop innovative solutions that balance legal and business needs
• Must demonstrate exceptional analytical strategic planning, issue identification and resolution skills
• Ability to operate independently and handle multiple, complex projects with a high degree of initiative required
• Demonstrated ability to organize complex information and to effectively report information to leadership
• Demonstrated Microsoft Office (Outlook, Word, Excel, PowerPoint, Teams) skills needed, SharePoint desirable
• Demonstrated learning mindset

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $77,100 - $132,200. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $77,100 - $115,710. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.