Senior Regulatory Analyst

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

📋 Description

• Oversee components of the departmental regulatory assessment and analysis

• Direct external audits and accreditation initiatives

• Engage in regulatory meetings, healthcare reform discussions, oversight, CMS, and compliance committee gatherings

• Act as the main contact for new internal and external business partners regarding regulatory activities and quality initiatives

• Track national and state healthcare regulations and relay updates to stakeholders

• Address business challenges and opportunities arising from government and commercial laws, rules, regulations, or guidelines affecting Consumer Delivery

• Execute and manage regulatory compliance obligations, including project leadership and governance

• Establish requirements for new Client and Group implementations

• Work collaboratively with leadership across Government Programs, Compliance, Healthcare Reform, Legal, Networks, Clinical Operations, Paper Claims, Member Materials, and IT

• Suggest policy and procedural modifications based on regulatory changes

• Represent departments during CMS, client, mock, and vendor audits

• Analyze audit feedback, initiate action items, propose enhancements, and summarize action plans

• Carry out other assigned responsibilities

⛳️ Requirements

• Bachelor's degree in business, finance, health services, or a related field, or an equivalent combination of education and relevant experience

• Minimum of 5 years of successful experience in project management and/or operations management within Pharmacy Benefit Management (PBM) or health insurance

• At least 2 years of experience with Medicare Part D, Medicaid, and/or federal regulatory frameworks

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

• Exceptional verbal and written communication and interpersonal abilities

• Skilled in meeting facilitation, conflict resolution, and consensus building

• Demonstrated client service and relationship-building capabilities

• Ability to juggle multiple projects simultaneously while working under pressure and adhering to tight deadlines

• Proven skills in problem-solving and crafting effective solutions

• Strong critical thinking and analytical abilities, including translating regulations into operational requirements

• Previous presentation experience is preferred

• Familiarity with Microsoft Project and Visio is preferred

• Extensive knowledge of CMS regulations is preferred

• Experience in Health Care Commercial Clinical review is preferred

• Capability to perform essential job functions, with reasonable accommodations available upon request

• Compliance with relevant legal, regulatory, contractual, and internal policy standards

🏝️ Benefits

• Potential salary range of $81,000.00–$138,000.00 based on experience and skills

• A variety of benefits, incentives, and additional compensation options are available; details can be found on the Benefits Page

• Reasonable accommodations for employees with disabilities

• Tobacco-Free Workplace