Regulatory Analyst (Remote)
$66,000–$106,000 year
RemoteUnited States
Job Summary
Lead regulatory assessments, external audits, and accreditation processes across Commercial, Medicare, Medicaid, and Health Insurance Marketplace departments. Serve as the primary point of contact for internal and external business partners regarding regulatory activity, quality efforts, and accreditation entities. Participate in external audits directed by CMS, Medicaid, NCQA, and commercial reviews while leading assigned department portions of ongoing accreditation processes. Assist in Regulatory Review Committee Meetings and Government Programs Compliance Committee Meetings to monitor new regulations and provide necessary updates. Lead client and auditor response efforts by validating regulatory requirements, reviewing processes, and maintaining gap status reporting. Manage change management related to regulatory requirements and other duties as assigned.
Required Qualifications
- Bachelor's degree in business, finance, health services or related area of study, or equivalent combination of education and/or relevant work experience
- 3 years of PBM, healthcare, and/or compliance work experience
- Must be eligible to work in the United States without need for work visa or residency sponsorship
- Must be eligible to work in the United States without the need for work visa or residency sponsorship
Desired Qualifications
- Strong verbal and written communication skills
- Demonstrated critical thinking and analysis skills with the ability to interpret regulations into operational requirements
- Strong attention to detail and commitment to meeting established timeliness
- Demonstrated knowledge of CMS regulations and Health Care Reform and extensive knowledge of clinical review and/or medication therapy management processes/procedures
- Proficient in standard software (Word, Visio, and Excel)
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