Regulatory Compliance Operations Liaison

PRIMARY PURPOSE OF THE ROLE

The Regulatory Compliance Operations Liaison serve as a key coordination point between Clinical Operations, Legal, Compliance, Licensing, and business stakeholders to support alignment with regulatory, accreditation, and jurisdiction requirements. This role interprets regulatory updates and translates them into clear operational guidance, supports utilization review and clinical pharmacy compliance activities, coordinates audit and accreditation readiness, and helps ensure regulatory communications, documentation, appeals, complaints, and operational processes are accurate, consistent, and appropriately vetted.

ARE YOU AN IDEAL CANDIDATE?

We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.

Essential Responsibilities

• Interprets regulatory updates and compliance guidance and translates requirements into clear, actionable direction for Clinical Operations, Utilization Review, Pharmacy Operations, and related business teams.
• PARTNERS WITH OPERATIONAL LEADERS TO ASSESS WORKFLOWS AGAINST ESTABLISHED POLICIES, PROCEDURES, JURISDICTIONAL REQUIREMENTS, AND ACCREDITATION STANDARDS; IDENTIFIES GAPS AND RECOMMENDS PROCESS IMPROVEMENTS.
• SUPPORTS IMPLEMENTATION AND COMMUNICATION OF REGULATORY, ACCREDITATION, AND COMPLIANCE-RELATED CHANGES ACROSS ASSIGNED CLINICAL PROGRAMS.
• SERVES AS A LIASON BETWEEN UTILIZATION REVIEW, PHARMACY OPERATIONS, LEGAL, COMPLIANCE, LICENSING, CLAIMS, AND OTHER STAKEHOLDERS TO ENSURE COMMUNICATIONS, PROCESSES, AND RESPONSES ARE APPROPRIATELY REVIEWED AND ALIGNED.
• SUPPORTS UTILIZATION REVIEW REGULATORY INQUIRIES, INCLUDING APPEALS, COMPLAINTS, AUDIT REQUESTS, AND OTHER REGULATORY RESPONSES; MANAGES AND TRIAGES THE UTILIZATION REVIEW COMPLIANCE MAILBOX TO ENSURE TIMELY ROUTING, TRACKING, FOLLOW-UP, AND RESPONSE.
• Maintains documentation, tracking logs, audit trails, and centralized records to support regulatory readiness, compliance oversight, and operational accountability; identifies and escalates compliance, licensing, regulatory, audit, appeal, complaint, or documentation risks to appropriate leadership.
• CORPORATES AND SUPPORTS STATE-LEVEL UTILIZATION REVIEW APPEALS IN COLLABORATION WITH CLAIMS, CLINICAL OPERATIONS, LEGAL, COMPLIANCE, AND OTHER APPROPRIATE STAKEHOLDERS.
• LEADS OR SUPPORTS DEVELOPMENT AND MAINTENANCE OF REGULATORY CORRESPONDENCE, STANDARD LETTER TEMPLATES, SOPs, OPERATIONAL DOCUMENTATION, AND COMPLIANCE-RELATED COMMUNICATIONS.

Qualifications

• Education & Licensing: Bachelor's degree from an accredited college or university preferred. Licenses as needed.
• Experience: Six (6) years of related experience or equivalent combination of education and experience required.