Regulatory Analyst Sr - Remote

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

Job Description

The Senior Regulatory Analyst is responsible for leading portions of departmental regulatory review and analysis, external audits and accreditation processes, and participates in committee review meetings within the Commercial, Medicare, Medicaid, and Health Insurance Marketplace for the assigned department. This position is responsible for being the primary point of contact for new internal and external business partners with regard to related regulatory activity and quality efforts involving utilization and/or medication therapy management, network management, client delegation agreements and accreditation entities, SOP development and maintenance, and development and maintenance of audit protocols.

Responsibilities

• Participate 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
• Monitor national and state healthcare regulation requirements and update appropriate stakeholders of changes or new requirements
• Take the lead on any new business issues and opportunities generated by Government and/or Commercial laws, rules, regulations or guidelines that impact Consumer Delivery
• Ensure successful implementation and execution of regulatory compliance requirements including project leadership and governance; ensure appropriate requirements are in place for new Client and Group implementations
• Establish and maintain engaged relationships with leadership of other functional areas within the corporation (can include Government Programs, Compliance, Healthcare Reform, Legal, Networks, Clinical Operations, Paper Claims, Member Materials, IT, etc.) to ensure effective collaboration, communication, and delivery of required regulations
• Recommend changes to policies and procedures based on regulatory changes
• Liaison with Internal Audit and External Audit teams to represent departments in CMS, Client, mock, and vendor audits
• Review audit feedback, initiate action items related to audit or compliance review findings, and recommend ideas for improvement and summarize action plans
• 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
• 5 years of successful project management and/or operations management experience related to, or within Pharmacy Benefit Management (PBM) or health insurance
• 2 years Medicare Part D, Medicaid, and/or federal regulatory experience
• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Excellent verbal and written communication skills including interpersonal skills necessary to drive results and deliver on commitments
• Proficient at meeting facilitation, conflict management, and consensus building
• Proven client service skills with a track record for building strong client relations
• Ability to handle multiple projects simultaneously and to work under pressure with strict timelines
• Proven problem solving and solution crafting skills
• Demonstrated critical thinking and analysis skills with the ability to interpret regulations into operational requirements

Preferred Qualifications

• Prior experience giving presentations
• Proficient in Microsoft Project and Visio
• Extensive knowledge of CMS regulations and Health Care

Minimum Physical Job Requirements

• Ability to travel up to 25% of the time
• Constantly required to sit, use hands to handle or feel, talk, and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• 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

Reporting Structure

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

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.