Sr. Regulatory Implementation Manager

The Senior Regulatory Implementation Manager is responsible for leading the operational implementation of regulatory and compliance-driven initiatives across the Medicare Advantage organization. This role partners with Regulatory Affairs, Compliance, Operations, Technology, Product, Clinical, and Business leaders to assess regulatory impacts, develop implementation plans, coordinate cross-functional activities, and ensure organizational readiness for new or revised Medicare Advantage requirements.

The Senior Regulatory Implementation Manager oversees end-to-end implementation of regulatory changes, ensuring that processes, systems, policies, communications, training, and operational workflows are aligned with federal and state regulatory requirements while minimizing business disruption and maintaining compliance.

This role serves as a central coordinator for enterprise regulatory initiatives and supports the organization’s ability to successfully respond to evolving CMS requirements, audit findings, and compliance obligations.

Job Responsibilities:

Regulatory Change Implementation

Lead implementation of new and revised regulatory requirements impacting Medicare Advantage operations.

Translate complex regulatory guidance into actionable implementation plans and operational requirements.

Coordinate enterprise-wide readiness efforts for regulatory and compliance initiatives.

Develop detailed project plans, milestones, dependencies, and implementation timelines.

Ensure timely and effective execution of regulatory initiatives across impacted business functions.

Regulatory Impact Assessment

Partner with Regulatory Affairs and Compliance teams to evaluate the operational impact of regulatory changes.

Facilitate impact assessments across departments including: Enrollment and Eligibility, Claims Operations, Grievances and Appeals, Member Services, Pharmacy Operations, Provider Operations, Care Management, Quality and Stars, Sales and Marketing, Risk Adjustment, Technology

Identify operational, process, staffing, system, and training impacts.

Document implementation requirements, risks, and recommendations.

Cross-Functional Program Management

Coordinate activities among business, operational, and technology teams to support compliance initiatives.

Facilitate implementation working groups and governance meetings.

Manage project risks, dependencies, issues, and escalation processes.

Drive accountability for completion of implementation deliverables.

Monitor project progress and ensure adherence to regulatory deadlines.

Operational Readiness

Develop and execute regulatory readiness plans.

Ensure policies, procedures, workflows, and job aids are updated to reflect regulatory requirements.

Coordinate business process redesign and operational changes.

Support workforce readiness through training and communication initiatives.

Conduct readiness reviews and implementation assessments prior to regulatory effective dates.

Technology & Systems Coordination

Partner with Technology and Enterprise Delivery teams to identify system changes required to support regulatory requirements.

Coordinate implementation of technology enhancements, system configurations, and vendor updates.

Oversee testing activities including:

User Acceptance Testing (UAT)

Business Validation Testing

Readiness Testing

Production Validation

Ensure regulatory requirements are fully incorporated into system solutions.

Audit & Compliance Support

Support implementation of corrective action plans resulting from CMS audits and compliance reviews.

Partner with Compliance teams to monitor implementation progress and remediation efforts.

Maintain implementation documentation and audit trails.

Assist with regulatory inquiries, audits, and operational validation activities.

Ensure evidence of implementation and compliance is properly documented.

Vendor & Delegated Entity Coordination

Coordinate implementation of regulatory requirements impacting third-party vendors and delegated entities.

Ensure vendors complete operational and system changes necessary to maintain compliance.

Monitor delegated entity readiness and implementation effectiveness.

Facilitate issue resolution and escalation management.

Executive Reporting & Governance

Develop executive-level implementation status reports and dashboards.

Present implementation progress, risks, and readiness assessments to leadership.

Provide recommendations regarding go-live readiness and risk mitigation strategies.

Support enterprise governance forums related to regulatory initiatives.

Experience:

Required:

Minimum (5) years’ experience in healthcare operations, compliance, regulatory affairs, implementation management, project management, or Medicare Advantage operations.

Education:

Required:

Bachelor’s degree in Business Administration, Healthcare Administration, Information Systems, Project Management, or related field.

Specialized Skills:

Required:

Experience managing complex, cross-functional initiatives involving regulatory or compliance requirements.

Strong understanding of project management principles and implementation methodologies.

Exceptional stakeholder management and communication skills.

Ability to interpret and operationalize regulatory requirements.

Strong organizational and analytical skills.

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.