Regulatory Compliance Analyst IV - Government Programs

In this role, you will be responsible for monitoring federal and state regulatory requirements that impact CareCentrix government programs (including Medicare Advantage and Managed Medicaid) and ensuring compliant implementation of legal and client obligations. You will also lead efforts to identify and drive continuous improvement initiatives to maintain compliance with all applicable laws and regulations. 

• Monitor and interpret federal and state laws and regulatory guidance affecting CareCentrix’s government programs (e.g., Medicare Advantage, Managed Medicaid). Analyze changes and communicate updates—both written and verbal—to impacted business areas.
• Provide cross-functionalguidance in developing and updating policies, procedures, and operational processes to ensure compliance with legal requirements.
• Support implementation across operational teams.
• Assist with compliance audits, including Medicare Part C program audits, reporting, and managed Medicaid audits, as required.
• Obtain and maintain operational licenses as needed to support program requirements.
• Support onboarding of new government program customers, ensuring compliance readiness.
• Drive continuous improvement by enhancing compliance tracking, trending, and reporting tools.
• Conduct internal audits and identify opportunities for process improvement.
• Design and deliver compliance training programs to promote understanding of regulatory requirements.
• Mentor and train junior team members within the Compliance Department’s regulatory team.

• Bachelor’s degree preferred; or a minimum of 7 years of experience in a managed care setting. JD or paralegal experience is a plus.
• 7+ years’ experience working with managed care laws impacting Medicare Advantage and/or managed Medicaid health insurers and delegated entities, including but not limited to, laws impacting utilization management, claims, network management, and credentialing.
• Proven experience in regulatory affairs and/or operations within HMOs, Managed Care Organizations, or government program health plans.
• Advanced legal research, organizational, and analytical skills.
• Strong written and verbal communication, including presentation skills and attention to detail.
• Proficiency in MS Office Suite (Excel, SharePoint, PowerPoint, OneNote).
• Deep understanding of Medicare Advantage guidelines and state regulations applicable to Managed Medicaid.

Other Job Specific Competencies:

• Ownership and Autonomous Decision-Making -Demonstrates strong ownership and accountability; operates with a high degree of autonomy and consistently exercises sound judgment in decision-making.
• Strategic Thinking: Able to anticipate future trends, align initiatives with long-term organizational objectives, and translate vision into actionable plans.
• Influence and Collaboration: Builds strong relationships across functions, persuades stakeholders effectively, and fosters a culture of teamwork.

• Pay Range: $95000 – $110000 / year plus corporate bonus incentive 
• Benefits: Medical, Dental, Vision, 401(k) with company match, HSA employer contributions, Dependent Care FSA employer contribution, Paid Time Off, Personal/Sick Time, Paid Parental Leave, and more. 
• Award winning culture: Keeps our company values at the heart of everything we do: We Care; We Do the Right Thing; We Strive for Excellence; We Think BIG; We Take our Work Seriously, Not Ourselves. 

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CareCentrix maintains a drug-free workplace. 

We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law. 

CareCentrix accepts applications on an ongoing basis until a candidate is identified.