Regulatory Analyst Sr - Minneapolis
15 hours ago
Job description
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve.
Looking for a purpose-driven career? Come build the future of pharmacy with us.Job Posting Title
Regulatory Analyst Sr - Remote
Job Description
The 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.
ResponsibilitiesParticipate 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 committees
Monitor national and state healthcare regulation requirements and update appropriate stakeholders of changes or new requirements
Take the lead on any new business issues and opportunities generated by Government and/or Commercial laws, rules, regulations or guidelines that impact Consumer Delivery
Ensure successful implementation and execution of regulatory compliance requirements including project leadership and governance; ensure appropriate requirements are in place for new Client and Group implementations
Establish 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 regulations
Recommend changes to policies and procedures based on regulatory changes
Liaison with Internal Audit and External Audit teams to represent departments in CMS, Client, mock, and vendor audits
Review audit feedback, initiate action items related to audit or compliance review findings, and recommend ideas for improvement and summarize action plans
Other duties as assigned
Minimum Qualifications
Bachelor's degree in business, finance, health services or related area of study, or equivalent combination of education and/or 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 Medicare Part D, Medicaid, and/or federal regulatory experience
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
Excellent verbal and written communication skills including interpersonal skills necessary to drive results and deliver on commitments
Proficient at meeting facilitation, conflict management, and consensus building
Proven client service skills with a track record for building strong client relations
Ability to handle multiple projects simultaneously and to work under pressure with strict timelines
Proven problem solving and solution crafting skills
Demonstrated critical thinking and analysis skills with the ability to interpret regulations into operational requirements
Preferred Qualifications
Prior experience giving presentations
Proficient in Microsoft Project and Visio
Extensive knowledge of CMS regulations and Health Care
Experience with regulatory reporting
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship.
Potential pay for this position ranges from $81, $138,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail ).
Prime 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, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We 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.
Positions will be posted for a minimum of five consecutive workdays.
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