Regulatory Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee segments of regulatory evaluations, external audits, and accreditation procedures for Commercial, Medicare, Medicaid, and Health Insurance Marketplace programs.

• Act as the main liaison for both internal and external business partners concerning regulatory activities and quality initiatives.

• Engage in CMS, Medicaid, NCQA, commercial, and client-driven external audits, annual assessments, and pre-delegation evaluations.

• Manage designated departmental segments of ongoing accreditation efforts.

• Support regulatory, healthcare reform, oversight, CMS user calls, and government programs compliance committee meetings.

• Direct clients, external auditors, and accreditation reviewers through Prime’s operational processes, providing necessary documentation and data files.

• Keep track of regulatory and accreditation gap status reporting and monitor workstream progress against plans.

• Lead responses to inquiries, including retrieving case files or samples, validating regulatory criteria, and reviewing processes.

• Direct change management initiatives related to regulatory requirements.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• Bachelor’s degree in business, finance, health services, or a related field, or a combination of education and/or relevant work experience.

• A minimum of 3 years of experience in PBM, healthcare, and/or compliance roles.

• Must be authorized to work in the United States without sponsorship for a visa or residency.

• Excellent verbal and written communication abilities.

• Strong critical thinking and analytical skills, particularly in translating regulations into operational requirements.

• High attention to detail and a dedication to meeting established deadlines.

• Preferred: familiarity with CMS regulations and Health Care Reform.

• Preferred: comprehensive knowledge of clinical review and/or medication therapy management processes and procedures.

• Proficient in Word, Visio, and Excel.

• Capability to perform essential job functions, with reasonable accommodations available as needed.

• Adherence to job-specific security responsibilities, controls, legal, regulatory, contractual, and internal policy requirements.

🏝️ Benefits

• Equal opportunity and affirmative action employer.

• Offers reasonable accommodations for applicants with disabilities.

• Maintains a Tobacco-Free Workplace.