Regulatory Analyst

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) **Job Description**: 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**: - 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 - 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 - Maintain regulatory and accreditation gap status reporting to keep all constituencies informed; track, manage, and report on work stream status against plan - 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 - 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 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 - 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 Potential pay for this position ranges from $62,100.00 - $93,300.00 based on location, experience and skills. - To review our Benefits, Incentives and Additional Compensation, visit our - Benefits Page - and click on the "Benefits at a glance" button for more detail.