Regulatory Specialist

Healthfirst

Regulatory Specialist at Healthfirst ensuring compliance with CMS and state regulations. Promoting improvements and managing contract changes across varied departments.

Posted 6/11/2026full-timeRemote • New Hampshire, New York, South Dakota • 🇺🇸 United StatesMid-LevelSenior💰 $68,900 - $99,620 per yearWebsite

About the role

Key responsibilities & impact

Responsible for promoting compliance with regulatory requirements with Healthfirst's different departments
Meets with the Regulatory department to organize pre-survey deliverables and conduct reviews of materials
Interacts with and represents the business unit
Responds to auditor requests and audits outcome results
Identifies organizational risks and helps implement process improvements
Manages, coordinates, and participates in the implementation of contract changes for all lines of business
Ensures that all process and contract changes are reflected in departmental policies and procedures
Monitors all Utilization Management/Care Management/Appeals & Grievances corrective action plans (CAPs) through completion
Assists in accreditation submissions, regulatory surveys, and internal audits
Provides support to Pharmacy Department related to regulatory implementation efforts

Requirements

What you’ll need

High School Diploma or GED
Bachelor's degree from an accredited institution (preferred)
Previous relevant compliance experience
Proficiency with Microsoft systems like Outlook, Excel, and Word
Strong knowledge of CMS and/or New York State DOH regulations
Compliance experience within a managed care environment
Working knowledge of project management
Intermediate MS Word, Excel, PowerPoint, Adobe Acrobat and corporate email systems
Ability to build and maintain positive relationships with cross-functional teams and interact with all levels of management
Time management, critical/creative thinking, project management, communication, and problem-solving skills

Benefits

Comp & perks

medical, dental and vision coverage
incentive and recognition programs
life insurance
401k contributions

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

compliance experienceproject managementregulatory surveysaccreditation submissionsprocess improvementsauditscontract managementUtilization ManagementCare Managementcorrective action plans

Soft Skills

time managementcritical thinkingcreative thinkingcommunicationproblem-solvingrelationship buildinginterpersonal skillsorganizational skillscoordinationrepresentation

Certifications

High School DiplomaGEDBachelor's degree