**Description**

+ Meets with the Regulatory department to organize pre-survey deliverables and conduct reviews of materials.
+ Interacts with and represents the business unit.
+ Responds to auditor requests and audits outcome results.
+ Identifies organizational risks and helps implement process improvements.
+ Manages, coordinates, and participates in the implementation of contract changes for all lines of business pertaining to Utilization Management/Care Management/Appeals & Grievances departments.
+ Ensures that all process and contract changes are reflected in departmental policies and procedures.
+ Reviews Healthfirst policies, procedures, and correspondence to ensure compliance with CMS and DOH regulations
+ Monitors all Utilization Management/Care Management/Appeals & Grievances corrective action plans (CAPs) through completion.
+ Reviews timeliness of all Utilization Management/Care Management/Appeals & Grievances monitoring reports to assess f...