Regulatory Analyst

Job not on LinkedIn

🔥 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Lead portions of regulatory assessments, external audits, and accreditation processes across Commercial, Medicare, Medicaid, and Health Insurance Marketplace programs • Serve as primary point of contact for internal and external business partners regarding regulatory activity and quality efforts • Participate in CMS, Medicaid, NCQA, commercial, and client-driven external audits, annual reviews, and pre-delegation reviews • Lead assigned department portions of ongoing accreditation processes • Assist with regulatory, healthcare reform, regulatory oversight, CMS user call, and government programs compliance committee meetings • Guide clients, external auditors, and accreditation reviewers through Prime’s business processes and provide required documentation and data files • Maintain regulatory and accreditation gap status reporting and track workstream status against plans • Lead responses to inquiries, including pulling case files or 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, 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 visa or residency sponsorship • Strong verbal and written communication skills • Critical thinking and analytical skills, including interpreting regulations into operational requirements • Strong attention to detail and commitment to established timelines • Preferred: knowledge of CMS regulations and Health Care Reform • Preferred: extensive knowledge of clinical review and/or medication therapy management processes and procedures • Proficiency in Word, Visio, and Excel • Ability to perform the essential functions of the job, with reasonable accommodations available when applicable • Compliance with job-specific security responsibilities, controls, legal, regulatory, contractual, and internal policy requirements

🏖️ Benefits

• Equal opportunity and affirmative action employer • Reasonable accommodations for applicants with disabilities • Tobacco-Free Workplace employer