Regulatory Analyst – Remote

About This Opportunity

We are representing a confidential pharmacy benefits management organization seeking a Regulatory Analyst to work remotely in the United States. This role offers the chance to lead critical regulatory compliance and accreditation processes across multiple lines of business including Commercial, Medicare, Medicaid, and Health Insurance Marketplace programs.

As the primary regulatory liaison for your assigned department, you'll coordinate external audits, manage accreditation activities, and ensure compliance with CMS regulations and industry standards. This position is ideal for a detail-oriented professional who can translate complex regulatory requirements into operational practices.

Responsibilities

• Lead assigned department portions of external audits directed by CMS, Medicaid, NCQA, and commercial clients, including annual reviews, pre-delegation reviews, and ongoing accreditation processes
• Participate in Regulatory Review Committee Meetings, Healthcare Reform Meetings, Regulatory Oversight Meetings, CMS User Calls, and Government Programs Compliance Committee activities
• Serve as the primary point of contact for internal and external business partners regarding regulatory activity and quality efforts involving utilization management and medication therapy management
• Guide clients, external auditors, and accreditation reviewers through business processes, providing appropriate documentation and data files related to accreditation standards
• Maintain regulatory and accreditation gap status reporting; track, manage, and report on work stream status against established plans
• Lead response efforts for regulatory inquiries related to your assigned department, including pulling case files, validating regulatory requirements, and reviewing processes against standards
• Manage change management initiatives related to evolving regulatory requirements
• Support SOP development and maintenance for clinical operations and PBM operations

What We're Looking For

Required Qualifications:

• Bachelor's degree in business, finance, health services, or related field, or equivalent combination of education and relevant work experience
• 3+ years of experience in pharmacy benefits management, healthcare, and/or compliance
• Strong verbal and written communication skills with ability to interact effectively with multiple stakeholders
• Demonstrated critical thinking and analysis skills with ability to interpret regulations into operational requirements
• Exceptional attention to detail and commitment to meeting established timelines
• Must be eligible to work in the United States without visa or residency sponsorship

Preferred Qualifications:

• Knowledge of CMS regulations and Healthcare Reform
• Extensive knowledge of clinical review and/or medication therapy management processes and procedures
• Proficiency in Microsoft Word, Visio, and Excel
• Experience with client delegation agreements and accreditation entities

How We Work With You

Get A Job.ai partners with leading healthcare organizations to connect talented professionals with meaningful opportunities. When you apply through our platform, our talent team will review your qualifications and conduct an initial screening. If there's a strong match, we'll submit your profile to our client for consideration and guide you through their interview process.

Please apply exclusively through Get A Job.ai. Do not contact the client organization directly, as all candidate communication is managed through our recruiting team to ensure a smooth and professional experience.

Pay

Compensation for this position will be determined based on your experience and skills. Our client offers competitive pay along with comprehensive benefits.

Get A Job.ai is an equal opportunity employer. We encourage applications from candidates of all backgrounds and experiences. All qualified applicants will receive consideration without regard to race, color, religion, gender, national origin, disability, age, veteran status, or any other legally protected class.