Regulatory Analyst Remote Jobs

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.
Job Posting Title
Regulatory Analyst Remote

The Regulatory Analyst is responsible for leading portions of regulatory assessment, external audits and accreditation processes within the Commercial, Medicare, Medicaid, and Health Insurance Marketplace for the assigned department. This position is responsible for primary point of contact for internal and external business partners regarding related regulatory activity and quality efforts involving utilization and/or medication therapy management, client delegation agreements and accreditation entities, SOP development and maintenance.
Responsibilities

• Lead all efforts for response to inquiries related to the assigned department, which may include pulling pertinent case files/samples, validating regulatory requirements, and review and validation of processes against requirements
• Take lead on change management related to regulatory requirements
• Maintain regulatory and accreditation gap status reporting to keep all constituencies informed; track, manage, and report on work stream status against plan
• Other duties as assigned
• Assist in Regulatory Review Committee Meetings, Healthcare Reform Meetings, Regulatory Oversight Meetings, CMS User Calls, and Government Programs Compliance Committee Meetings to monitor new regulations and provide necessary updates to these committees
• Lead the Client, external auditor, and/or accreditation reviewer through Prime’s business processes and provide the appropriate documentation and/or data files as they relate to accreditation standards or regulations
• Participate in portions of external audits as directed by the Centers for Medicare & Medicaid Services (CMS), Medicaid, NCQA, participate in commercial and Client driven external audits, annual reviews, and pre-delegation reviews and lead assigned department (i.e. Clinical Operations, PBM Operations) portions of ongoing Accreditation processes

Required Qualifications

• Must be eligible to work in the United States without need for work visa or residency sponsorship
• 3 years of PBM, healthcare, and/or compliance work experience
• Bachelor’s degree in business, finance, health services or related area of study, or equivalent combination of education and/or relevant work experience

Additional 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

Preferred Qualifications

• 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)

Minimum Physical Job Requirements

• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus
• Frequently required to reach with hands and arms
• Constantly required to sit, use hands to handle or feel, talk, and hear
• Occasionally required to stand, walk and stoop, kneel, and crouch

Reporting Structure

• Reports to a manager or director in the Clinical Operations, Contact Center, Network Management or PBM Operations department

Potential pay for this position ranges from $63,400.00 - $95,200.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.