Regulatory Analyst Sr - Remote

job
  • Prime Therapeutics
Job Summary
Location
Baton Rouge ,LA 70873
Job Type
Contract
Visa
Any Valid Visa
Salary
PayRate
Qualification
BCA
Experience
2Years - 10Years
Posted
04 Dec 2024
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Job Description

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.nnJob Posting TitlennRegulatory Analyst Sr - RemotennJob DescriptionnnThe Senior Regulatory Analyst is responsible for leading portions of departmental regulatory review and analysis, external audits and accreditation processes, and participates in committee review meetings within the Commercial, Medicare, Medicaid, and Health Insurance Marketplace for the assigned department. This position is responsible for being the primary point of contact for new internal and external business partners with regard to related regulatory activity and quality efforts involving utilization and/or medication therapy management, network management, client delegation agreements and accreditation entities, SOP development and maintenance, and development and maintenance of audit protocols.nnResponsibilitiesnnParticipate 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 committeesnnMonitor national and state healthcare regulation requirements and update appropriate stakeholders of changes or new requirementsnnTake the lead on any new business issues and opportunities generated by Government and/or Commercial laws, rules, regulations or guidelines that impact Consumer DeliverynnEnsure successful implementation and execution of regulatory compliance requirements including project leadership and governance; ensure appropriate requirements are in place for new Client and Group implementationsnnEstablish and maintain engaged relationships with leadership of other functional areas within the corporation (can include Government Programs, Compliance, Healthcare Reform, Legal, Networks, Clinical Operations, Paper Claims, Member Materials, IT, etc.) to ensure effective collaboration, communication, and delivery of required regulationsnnRecommend changes to policies and procedures based on regulatory changesnnLiaison with Internal Audit and External Audit teams to represent departments in CMS, Client, mock, and vendor auditsnnReview audit feedback, initiate action items related to audit or compliance review findings, and recommend ideas for improvement and summarize action plansnnOther duties as assignednnRequired QualificationsnnBachelor’s degree in business, finance, health services or related area of study, or equivalent combination of education and/or relevant work experiencenn5 years of successful project management and/or operations management experience related to, or within Pharmacy Benefit Management (PBM) or health insurancenn2 years Medicare Part D, Medicaid, and/or federal regulatory experiencennMust be eligible to work in the United States without need for work visa or residency sponsorshipnnAdditional QualificationsnnExcellent verbal and written communication skills including interpersonal skills necessary to drive results and deliver on commitmentsnnProficient at meeting facilitation, conflict management, and consensus buildingnnProven client service skills with a track record for building strong client relationsnnAbility to handle multiple projects simultaneously and to work under pressure with strict timelinesnnProven problem solving and solution crafting skillsnnDemonstrated critical thinking and analysis skills with the ability to interpret regulations into operational requirementsnnPreferred QualificationsnnPrior experience giving presentationsnnProficient in Microsoft Project and VisionnExtensive knowledge of CMS regulations and Health CarennMinimum Physical Job RequirementsnnAbility to travel up to 25% of the timennConstantly required to sit, use hands to handle or feel, talk, and hearnnFrequently required to reach with hands and armsnnOccasionally required to stand, walk and stoop, kneel, and crouchnnOccasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 poundsnnSpecific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focusnnReporting StructurennReports to a manager or director in the Clinical Operations, Contact Center, Network Management or PBM Operations departmentnnPotential pay for this position ranges from $74,500.00 - $111,700.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.nnTo review our Benefits, Incentives and Additional Compensation, visit our Benefits Page ( and click on the "Benefits at a glance" button for more detail.nnPrime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.nnWe welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.nnPrime Therapeutics LLC is a Tobacco-Free Workplace employer.nnPositions will be posted for a minimum of five consecutive workdays.nnPrime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.nnIf you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives.nnPrime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law.nnWe welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.nnPrime Therapeutics LLC is a Tobacco-Free Workplace employer.nnIf you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email

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