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 Sr - Remote

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 departmentPotential pay for this position ranges from $74,500.00 - $111,700.00 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 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.

Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.

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.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].