Regulatory Analyst

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $66k - $106k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1998

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Prime Therapeutics is a trusted pharmacy solutions provider dedicated to transforming health care through innovation and transparency. The company offers a wide range of services including clinical solutions for improved member outcomes, drug access and affordability, specialty drug management, and condition management for chronic health issues. With over 7,000 employees, Prime Therapeutics aims to challenge norms in the pharmacy industry, providing exceptional experiences and simplifying the complex for millions across the nation. Their mission goes beyond profit, focusing on creating transformative impacts with long-term solutions, utilizing modern technology and holistic approaches in specialty pharmacy management. Owned by mission-driven partners, Prime Therapeutics emphasizes true transparency and conflict-free service, fostering a culture of care and shared purpose in health care.

📋 Description

• Participate in external audits directed by CMS and Medicaid, commercial and client-driven external audits, annual reviews, and pre-delegation reviews • Lead assigned department portions of ongoing accreditation processes • Assist in Regulatory Review Committee, Healthcare Reform, Regulatory Oversight, CMS User Call, and Government Programs Compliance Committee meetings • Monitor new regulations and provide necessary updates to committees • Lead clients, external auditors, and accreditation reviewers through Prime's business processes • Provide documentation and data files related to accreditation standards or regulations • Maintain regulatory and accreditation gap status reporting • Track, manage, and report workstream status against plan • Lead responses to inquiries related to the assigned department, including pulling case files/samples, validating regulatory requirements, and reviewing processes • Lead change management related to regulatory requirements • Perform other duties as assigned

🎯 Requirements

• 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 • 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 • Knowledge of CMS regulations and Health Care Reform preferred • Extensive knowledge of clinical review and/or medication therapy management processes/procedures preferred • Proficient in Word, Visio, and Excel preferred • Must comply with security responsibilities, applicable legal, regulatory, contractual requirements, and internal policies and procedures • Must be able to perform the essential functions of the job; reasonable accommodations available when requested

🏖️ Benefits

• Benefits, incentives and additional compensation offered; details provided on the employer’s Benefits Page • Equal opportunity and affirmative action employer • Reasonable accommodations for employees with disabilities • Tobacco-Free Workplace