Corporate Governance - Analyst, Regulatory Compl Sr

Overview

On Site
BASED ON EXPERIENCE
Contract - Independent
Contract - W2
Contract - 12+ mo(s)

Skills

SKILLS TO BE ASSIGNED

Job Details

Now Hiring: Sr. Regulatory Compliance Analyst - PBM Communications Compliance

Location: Remote (USA)

Contract-to-Hire | Opportunity to Transition to Permanent Role

Employment Type: Full-Time

Industry: Pharmacy Benefit Management (PBM), Healthcare Compliance

About the Role:

We re seeking a Senior Regulatory Compliance Analyst who specializes in pharmacy communications compliance. In this critical role, you will review and ensure all member and provider-facing materials meet regulatory standards from CMS, URAC, and state authorities. You ll serve as the compliance gatekeeper for pharmacy utilization communications including prior authorization (PA) and denial letters, formulary notices, and more.

This is not a generic regulatory role we are looking for pharmacy regulation experts who understand the language and formatting required in government-regulated communications.

Key Responsibilities:

  • Audit and validate pharmacy communications to ensure compliance with CMS, URAC, HIPAA, and state-mandated standards.
  • Collaborate cross-functionally with legal, regulatory, and compliance teams to mitigate risk and ensure document accuracy.
  • Track, review, and implement regulatory updates and communication standards.
  • Manage version control and maintain proper documentation of all regulated pharmacy materials.
  • Serve as the subject matter expert during regulatory audits, investigations, and legal escalations.
  • Respond to formal inquiries from regulatory agencies (e.g., MIA, VBOI, DISB) and external stakeholders including members and government bodies.
  • Participate in litigation support, including documentation reviews, legal strategy meetings, and testimony preparation.

Must-Have Skills:

  • 5+ years in regulatory compliance or pharmacy benefit communications
  • Deep understanding of CMS, URAC, and state pharmacy benefit regulations
  • Familiarity with Utilization Management (UM) and Prior Authorization (PA) letter requirements
  • Excellent written communication and auditing skills
  • Strong collaboration and relationship management abilities
  • Knowledge of HIPAA, plain language writing, and regulated healthcare communication standards

Key Focus Areas & Keywords:

  • Pharmacy compliance (CMS / URAC)
  • Regulatory communication reviews
  • Prior Authorization (PA) / denial letters
  • Medicare/Medicaid compliance
  • Pharmacy benefit documentation
  • Member & provider letter audits
  • Risk mitigation and version control
  • Federal/state regulatory interpretation

Qualifications:

  • Bachelor s degree in a relevant field
  • (In lieu of a degree, 4 additional years of experience will be considered)
  • Strong understanding of regulatory frameworks in pharmacy benefits
  • Excellent verbal and professional writing skills
  • Comfortable working in a fast-paced, deadline-driven environment

Preferred:

  • Experience working in a PBM or health plan setting
  • Advanced knowledge of adverse benefit determinations, formulary notifications, and other CMS-mandated communications
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