Senior Regulatory Analyst

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $81k - $138k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

🦅 H1B Visa Sponsor

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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

• Lead portions of departmental regulatory review and analysis • Lead external audits and accreditation processes • Participate in regulatory, healthcare reform, oversight, CMS, and compliance committee meetings • Serve as primary point of contact for new internal and external business partners on regulatory activity and quality efforts • Monitor national and state healthcare regulations and communicate changes to stakeholders • Lead business issues and opportunities arising from Government and Commercial laws, rules, regulations, or guidelines impacting Consumer Delivery • Implement and execute regulatory compliance requirements, including project leadership and governance • Ensure requirements are established for new Client and Group implementations • Collaborate with leadership across Government Programs, Compliance, Healthcare Reform, Legal, Networks, Clinical Operations, Paper Claims, Member Materials, and IT • Recommend policy and procedure changes based on regulatory developments • Represent departments in CMS, client, mock, and vendor audits • Review audit feedback, initiate action items, recommend improvements, and summarize action plans • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in business, finance, health services, or related area, or equivalent combination of education and 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 of Medicare Part D, Medicaid, and/or federal regulatory experience • Must be eligible to work in the United States without work visa or residency sponsorship • Excellent verbal and written communication and interpersonal skills • Proficiency in meeting facilitation, conflict management, and consensus building • Proven client service and client relationship-building skills • Ability to manage multiple projects simultaneously under pressure and strict timelines • Proven problem-solving and solution-crafting skills • Critical thinking and analysis skills, including interpreting regulations into operational requirements • Prior presentation experience preferred • Proficiency in Microsoft Project and Visio preferred • Extensive CMS regulations knowledge preferred • Health Care Commercial Clinical review experience preferred • Ability to perform essential job functions, with reasonable accommodations available when requested • Compliance with applicable legal, regulatory, contractual, and internal policy requirements

🏖️ Benefits

• Potential pay range of $81,000.00–$138,000.00 based on experience and skills • Benefits, incentives, and additional compensation are offered; details are provided on the Benefits Page • Reasonable accommodations for employees with disabilities • Tobacco-Free Workplace