Senior Manager, Regulatory and Business Operations

Reporting to the Associate Director of Operations Enablement and Compliance, the Senior Manager of Regulatory and Business Operations will lead the Operations department’s efforts in managing regulatory compliance, grievances, and clinical and operational audits. This role will also oversee compliance requirements related to CHIP and other regulatory needs, ensuring adherence to state and federal guidelines. This is a full-time, remote position with the option to work hybrid or in-office at our New York City headquarters.

What you’ll be doing: 

• Regulatory Compliance
• Lead the Regulatory and Business Operations team, including oversight of grievance and complaints processes, audits, and other regulatory compliance-related initiatives.
• Serve as a subject matter expert within Operations on regulatory requirements, including CHIP, providing guidance to internal teams.
• Develop and execute strategies to ensure timely and effective regulatory compliance.
• Partner with internal stakeholders to develop and improve policies, procedures, and training programs.
• Grievance & Complaint Management:
• Oversee the complaints and grievance and appeals processes ensuring compliance with state health department regulations.
• Collaborate with internal departments, including Legal and Corporate Compliance, to resolve complex grievance and appeal cases.
• Ensure grievance reporting and documentation are accurate and submitted within required timeframes.
• Audits:
• Lead clinical and operational audit initiatives, including preparation, execution, and follow-up actions.
• Surface areas of improvement based on audit outcomes and work with cross-functional teams to implement corrective measures.
• Ensure the organization’s readiness for internal and external audits, including but not limited to audits by regulatory agencies and Spring Health customers.
• Team Management and Collaboration:
• Supervise and mentor direct reports, including roles such as the Senior Ops Compliance Associate.
• Foster strong cross-functional relationships to promote alignment between Regulatory Compliance, as well as other operational functions.
• Participate in Grievances and Appeals committee meetings and other cross-departmental initiatives.

What success looks like in this role: 

• Regulatory initiatives, including grievances, appeals, and audits, executed effectively within required timelines and with measurable improvements in compliance and member satisfaction.
• Successful completion of internal and external audits with minimal deficiencies or findings.
• Timely and accurate submission of regulatory compliance reporting and adherence to regulatory requirements.
• Continuous improvement in regulatory compliance processes and reduction in grievance and audit deficiencies.
• Effective mentorship and development of team members, fostering a high-performing Regulatory Compliance team.

What we expect from you: 

• Bachelor’s degree or equivalent experience required; advanced degree in healthcare administration, compliance, or related field is a plus.
• 6+ years of experience in regulatory compliance, grievance management, or audit functions within the healthcare industry.
• Strong understanding of grievance and appeals regulations and clinical/operational audit processes.
• Proven leadership experience with the ability to manage and develop high-performing teams.
• Exceptional communication skills (written, verbal, and interpersonal) to navigate complex regulatory environments.
• Strong analytical and organizational skills, with attention to detail and the ability to manage multiple priorities simultaneously.
• Demonstrated ability to develop innovative solutions to regulatory and operational challenges.

Bonus: Proficiency with tools such as Jira, Zendesk, Looker, and other business intelligence platforms.

Bonus: Certifications such as CHC (Certified in Healthcare Compliance) or similar.

The target base salary range for this position is $110,000 - $142,500, and is part of a competitive total rewards package including stock options and benefits. Individual pay may vary from the target range and is determined by a number of factors including experience, location, internal pay equity, and other relevant business considerations. We review all employee pay and compensation programs annually using Radford Global Compensation Database at minimum to ensure competitive and fair pay. 

Benefits provided by Spring Health:

Note: We have even more benefits than listed here and below, your recruiter will provide more in-depth information as you continue in the interview process. Benefits are subject to individual plan requirements and eligibility criteria.

• Health, Dental, Vision benefits start on your first day at Spring. You and your dependents also receive access to One Medical accounts HSA and FSA plans are also available, with Spring contributing up to $1K for HSAs, depending on your plan type.
• Employer sponsored 401(k) match of up to 2% for retirement planning
• A yearly allotment of no cost visits to the Spring Health network of therapists, coaches, and medication management providers for you and your dependents.
• We offer competitive paid time off policies including vacation, sick leave and company holidays.
• We offer parental leave up to 18 weeks, depending on your eligibility including tenure and medical situation.
• Access to Noom, a weight management program—based in psychology, that’s tailored to your unique needs and goals. 
• Access to fertility care support through Carrot, in addition to $4,000 reimbursement for related fertility expenses.
• Access to Wellhub,  which connects employees to the best options for fitness, mindfulness, nutrition, and sleep in one subscription
• Access to BrightHorizons, which provides sponsored child care, back-up care, and elder care
• Up to $1,000 Professional Development Reimbursement a year.
• $200 per year donation matching to support your favorite causes.