Senior Regulatory Specialist in United States at Jobgether
Explore Related Opportunities
Job Description
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Senior Regulatory Specialist in the United States.
This role plays a key part in ensuring regulatory compliance across pharmacy operations within a complex healthcare environment. You will monitor evolving federal and state regulations, interpret their impact, and help ensure proper implementation across business processes and vendor partners. Acting as a critical bridge between regulatory affairs, pharmacy teams, and leadership, you will support compliance initiatives that directly impact patient safety and program integrity. The position also involves significant analytical work, including claims review and fraud, waste, and abuse detection. You will contribute to managing the Restricted Recipient Program while coordinating cross-functional efforts and regulatory reporting. This is a high-visibility role requiring strong attention to detail, regulatory expertise, and the ability to operate effectively in a fast-paced, mission-driven environment.
- Monitor and interpret regulatory updates from CMS, State Departments of Health, and other governing bodies, ensuring timely awareness and action.
- Communicate regulatory guidance to pharmacy teams and support interpretation in collaboration with legal and regulatory affairs stakeholders.
- Support regulatory implementation efforts, including tracking deliverables, coordinating meetings, documenting actions, and reporting progress to leadership.
- Manage and support Restricted Recipient Program (RRP) operations, including committee coordination, documentation, and compliance monitoring.
- Analyze pharmacy and medical claims data to identify fraud, waste, and abuse trends and escalate findings for review.
- Process RRP-related notices, provider notifications, restriction changes, and member-related determinations and appeals.
- Participate in regulatory and OMIG meetings, ensuring follow-up actions are identified and implemented across internal teams.
- Support audits, corrective action plans, and continuous improvement initiatives to strengthen compliance processes.
- High school diploma or GED required; bachelor’s degree preferred.
- Strong understanding of CMS and state regulatory frameworks, particularly in Medicaid environments.
- Experience in managed care, pharmacy operations, or healthcare compliance strongly preferred.
- Knowledge of New York State Department of Health and Medicaid regulatory requirements is an advantage.
- Strong analytical skills with the ability to review and interpret claims and operational data.
- Excellent organizational skills with the ability to manage multiple regulatory workflows and deadlines.
- Strong communication skills to liaise between technical, clinical, and regulatory stakeholders.
- Detail-oriented, process-driven, and comfortable working in a highly regulated environment.
- Competitive salary range: $73,400 – $120,360 depending on location and experience
- Comprehensive medical, dental, and vision insurance
- 401(k) retirement contributions
- Incentive and recognition programs
- Life insurance coverage
- Paid time off and holidays
- Career development and training opportunities
- Inclusive, equal-opportunity workplace culture.