Job Summary

A health insurance company has an open position for a Remote Senior Clinical Regulatory and Compliance Manager.

Core Responsibilities Include:

• Develop, implement, and monitor processes to manage clinical audits
• Partner with key stakeholders such as Legal, Regulatory, Compliance, Appeals and Grievances, Finance, and Pharmacy
• Give timely and effective responses to audit inquiries and requests

Skills and Requirements Include:

• Associate’s degree
• Relevant prior experience such as experience working at a managed care health plan or delegated vendor
• Experience with pharmacy benefits management
• Demonstrated professionalism and leadership skills along with ability to develop, direct, and support a team
• Healthcare regulatory compliance experience
• Excellent time and project management, communication, critical/creative thinking, and problem-solving skills